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Deng D, Ostrem JL, Nguyen V, Cummins DD, Sun J, Pathak A, Little S, Abbasi-Asl R. Interpretable video-based tracking and quantification of parkinsonism clinical motor states. NPJ Parkinsons Dis 2024; 10:122. [PMID: 38918385 PMCID: PMC11199701 DOI: 10.1038/s41531-024-00742-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 06/14/2024] [Indexed: 06/27/2024] Open
Abstract
Quantification of motor symptom progression in Parkinson's disease (PD) patients is crucial for assessing disease progression and for optimizing therapeutic interventions, such as dopaminergic medications and deep brain stimulation. Cumulative and heuristic clinical experience has identified various clinical signs associated with PD severity, but these are neither objectively quantifiable nor robustly validated. Video-based objective symptom quantification enabled by machine learning (ML) introduces a potential solution. However, video-based diagnostic tools often have implementation challenges due to expensive and inaccessible technology, and typical "black-box" ML implementations are not tailored to be clinically interpretable. Here, we address these needs by releasing a comprehensive kinematic dataset and developing an interpretable video-based framework that predicts high versus low PD motor symptom severity according to MDS-UPDRS Part III metrics. This data driven approach validated and robustly quantified canonical movement features and identified new clinical insights, not previously appreciated as related to clinical severity, including pinkie finger movements and lower limb and axial features of gait. Our framework is enabled by retrospective, single-view, seconds-long videos recorded on consumer-grade devices such as smartphones, tablets, and digital cameras, thereby eliminating the requirement for specialized equipment. Following interpretable ML principles, our framework enforces robustness and interpretability by integrating (1) automatic, data-driven kinematic metric evaluation guided by pre-defined digital features of movement, (2) combination of bi-domain (body and hand) kinematic features, and (3) sparsity-inducing and stability-driven ML analysis with simple-to-interpret models. These elements ensure that the proposed framework quantifies clinically meaningful motor features useful for both ML predictions and clinical analysis.
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Affiliation(s)
- Daniel Deng
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Jill L Ostrem
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Vy Nguyen
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Daniel D Cummins
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Julia Sun
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | | | - Simon Little
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
| | - Reza Abbasi-Asl
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA, USA.
- UCSF Weill Institute for Neurosciences, San Francisco, CA, USA.
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2
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Mermelstein S, Barbosa P, Kaski D. Neurological gait assessment. Pract Neurol 2024; 24:11-21. [PMID: 38135498 DOI: 10.1136/pn-2023-003917] [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] [Accepted: 11/04/2023] [Indexed: 12/24/2023]
Abstract
Gait disorders are a common feature of neurological disease. The gait examination is an essential part of the neurological clinical assessment, providing valuable clues to a myriad of causes. Understanding how to examine gait is not only essential for neurological diagnosis but also for treatment and prognosis. Here, we review aspects of the clinical history and examination of neurological gait to help guide gait disorder assessment. We focus particularly on how to differentiate between common gait abnormalities and highlight the characteristic features of the more prevalent neurological gait patterns such as ataxia, waddling, steppage, spastic gait, Parkinson's disease and functional gait disorders. We also offer diagnostic clues for some unusual gait presentations, such as dystonic, stiff-person and choreiform gait, along with red flags that help differentiate atypical parkinsonism from Parkinson's disease.
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Affiliation(s)
- Sofia Mermelstein
- Neurology, Pedro Ernesto University Hospital, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Pedro Barbosa
- Divisão de Neurologia, Grupo de Distúrbios do Movimento, Universidade de São Paulo Hospital das Clínicas, Sao Paulo, São Paulo, Brazil
| | - Diego Kaski
- Clinical and Movement Neurosciences, UCL, London, UK
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3
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Batheja V, Fish M, Balar AB, Hogg JP, Lakhani DA, Khan M. Progressive supranuclear palsy: A case report and brief review of the literature. Radiol Case Rep 2024; 19:250-253. [PMID: 38028282 PMCID: PMC10630753 DOI: 10.1016/j.radcr.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 08/28/2023] [Accepted: 09/01/2023] [Indexed: 12/01/2023] Open
Abstract
Atypical Parkinsonian syndromes are a subset of progressive neurodegenerative disorders that present with signs of Parkinson's disease. However, due to multisystem degeneration, the atypical Parkinsonian syndromes have additional symptoms that are often referred to as Parkinson-plus syndromes. The most well-studied subsets include progressive supranuclear palsy (PSP), multiple system atrophy (MSA), corticobasal degeneration (CBD), and Lewy body dementia. Specifically, progressive supranuclear palsy is a tauopathy neurodegenerative disorder that presents with parkinsonism symptoms along with postural instability, vertical saccade, and vertical gaze palsy. Here, we present a case of PSP and provide a brief review of the literature.
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Affiliation(s)
- Vivek Batheja
- Department of Internal Medicine, George Washington University Hospital, Washington, DC
| | - Morgan Fish
- Department of Radiology, West Virginia University, Morgantown, WV
| | - Aneri B. Balar
- Department of Radiology, West Virginia University, Morgantown, WV
| | - Jeffery P. Hogg
- Department of Radiology, West Virginia University, Morgantown, WV
| | | | - Musharaf Khan
- Department of Radiology, West Virginia University, Morgantown, WV
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4
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Jung CK, Kim J, Rhim HC. Validation of an Ear-Worn Wearable Gait Analysis Device. SENSORS (BASEL, SWITZERLAND) 2023; 23:1244. [PMID: 36772282 PMCID: PMC9921138 DOI: 10.3390/s23031244] [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: 12/09/2022] [Revised: 01/10/2023] [Accepted: 01/19/2023] [Indexed: 06/18/2023]
Abstract
Wearable devices capable of measuring gait parameters may provide a means to more economical gait analysis compared to conventional equipment comprising of a motion capture system and a forced treadmill. Beflex Coach (Beflex, Republic of Korea) is one such device but worn on the ear as Bluetooth earphones, unlike other wearables worn on the wrist, feet, or torso. In this study, the validity of the device was examined against a motion capture system and a forced treadmill for walking and running parameters. Five walking parameters (cadence, single support time, double support time, vertical oscillation (VO), and instantaneous vertical loading rate (IVLR)) and six running parameters (cadence, stance time, flight time, peak force, VO, and IVLR) were studied. Twenty young adults participated in walking or running on a forced treadmill at different speeds (walking: 0.8, 1.25, and 1.7 m/s for walking; running: 2, 2.5, and 3 m/s) while the two systems operated simultaneously. As a result, all parameters showed excellent associations (ICC > 0.75) and good agreements in Bland-Altman plots. The results of the study support the potential use of the ear-worn device as an inexpensive gait analysis equipment.
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Affiliation(s)
- Chang Keun Jung
- Beflex Research Center, Beflex Inc., Seoul 06628, Republic of Korea
| | - Jinkyuk Kim
- Beflex Research Center, Beflex Inc., Seoul 06628, Republic of Korea
| | - Hye Chang Rhim
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA 02129, USA
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02115, USA
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5
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Dong X, Ge Y, Li K, Li X, Liu Y, Xu D, Wang S, Gu X. A high-pressure resistant ternary network hydrogel based flexible strain sensor with a uniaxially oriented porous structure toward gait detection. SOFT MATTER 2022; 18:9231-9241. [PMID: 36427226 DOI: 10.1039/d2sm01286c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Gait abnormalities have been widely investigated in the diagnosis and treatment of neurodegenerative diseases. However, it is still a great challenge to achieve a comfortable, convenient, sensitive and high-pressure resistant flexible gait detection sensor for real-time health monitoring. In this work, a polyaniline (PANI)@(polyacrylic acid (PAA)-polyvinyl alcohol (PVA)) (PANI@(PVA-PAA)) ternary network hydrogel with a uniaxially oriented porous featured structure was successfully prepared using a simple freeze-thaw method and in situ polymerization. The PANI@(PVA-PAA) hydrogel shows excellent compressive mechanical properties (423.44 kPa), favorable conductivity (2.02 S m-1) and remarkable durability (500 loading-unloading cycle), and can sensitively detect the effect of pressure with a fast response time (200 ms). The PANI@(PVA-PAA) hydrogel assembled into a flexible sensor can effectively identify the movement state of the shoulder, knee and even the sole of the plantar for gait detection. The uniaxially oriented porous structure enables the hydrogel-based sensor to have a high rate of change in the longitudinal direction and can effectively distinguish various gaits. The construction of a hydrogen bond between PANI and the PVA-PAA hydrogel ensures the uniform distribution of PANI in the hydrogel to form a ternary network structure, which improves the pressure resistance and conductivity of the PANI@(PVA-PAA) hydrogel. Thus, PANI@(PVA-PAA) hydrogel flexible sensor for gait detection can not only effectively monitor some serious diseases but also detect some unscientific exercise in people's daily life.
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Affiliation(s)
- Xin Dong
- Shandong Provincial Key Laboratory of Preparation and Measurement of Building Materials, University of Jinan, China.
| | - Yaqing Ge
- College of Medicine and Nursing, Shandong Provincial Engineering Laboratory of Novel Pharmaceutical Excipients, Sustained and Controlled Release Preparations, Dezhou University, China.
| | - Keyi Li
- College of Chemistry and Chemical Engineering, Shandong University of Technology, China
| | - Xinyi Li
- College of Medicine and Nursing, Shandong Provincial Engineering Laboratory of Novel Pharmaceutical Excipients, Sustained and Controlled Release Preparations, Dezhou University, China.
| | - Yong Liu
- College of Medicine and Nursing, Shandong Provincial Engineering Laboratory of Novel Pharmaceutical Excipients, Sustained and Controlled Release Preparations, Dezhou University, China.
| | - Dongyu Xu
- College of Civil Engineering and Architecture, Linyi University, China
| | - Shoude Wang
- Shandong Provincial Key Laboratory of Preparation and Measurement of Building Materials, University of Jinan, China.
| | - Xiangling Gu
- College of Medicine and Nursing, Shandong Provincial Engineering Laboratory of Novel Pharmaceutical Excipients, Sustained and Controlled Release Preparations, Dezhou University, China.
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Pantelyat A, Dayanim G, Kang K, Turk B, Pagkatipunan R, Huenergard SK, Mears A, Bang J. Rhythmic auditory cueing in atypical parkinsonism: A pilot study. Front Neurol 2022; 13:1018206. [PMID: 36388209 PMCID: PMC9650086 DOI: 10.3389/fneur.2022.1018206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/03/2022] [Indexed: 11/30/2022] Open
Abstract
Rhythmic auditory cueing (RAC) can improve gait parameters in neurological disorders such as Parkinson's disease and stroke. However, there is a lack of research on the effects of RAC in patients with atypical parkinsonian disorders (APD). Using a smartphone metronome application, we aimed to investigate the immediate effects of RAC in patients with clinically diagnosed APD, namely Progressive Supranuclear Palsy (PSP-Richardson Syndrome and other variants, PSP-nonRS), Corticobasal Syndrome (CBS), Multiple System Atrophy (MSA), and Dementia with Lewy Bodies (DLB). A total of 46 APD participants (25 PSP, 9 CBS, 8 MSA and 4 DLB; age: mean = 70.17, standard deviation = 7.15) walked at their preferred pace for 2 min without any rhythmic auditory cueing (RAC). Participants then walked the same path for another 2 min with RAC set at a tempo 10% faster than the baseline cadence of each participant. After a 10–15-min break, participants walked the same path for another 2 min without RAC to observe for carryover effects. Gait parameters [cadence (steps/minute), gait velocity (meters/minute), and stride length (centimeters)] were collected at baseline, during RAC, and post-RAC. There was a significant improvement in cadence in all participants from baseline to during RAC and post-RAC (corrected p-values = 0.009 for both). Gait velocity also improved from baseline to during RAC and post-RAC in all participants, although this improvement was not significant after correcting for multiple comparisons. The changes in cadence and gait velocity were most pronounced in PSP. In addition, our exploratory analysis showed that the cadence in the suspected TAU group (PSP+CBS) showed a significant improvement from baseline to during RAC and post-RAC (corr. p-value = 0.004 for both). This pilot study using short-term RAC in APD patients demonstrated improvements in cadence and velocity. There is an urgent need for effective gait rehabilitation modalities for patients with APD, and rhythmic cueing can be a practical and useful intervention to improve their gait pattern.
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Affiliation(s)
- Alexander Pantelyat
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Center for Music and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- *Correspondence: Alexander Pantelyat
| | - Gabriel Dayanim
- College of Computer, Mathematical, and Natural Sciences, University of Maryland, College Park, MD, United States
| | - Kyurim Kang
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Center for Music and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Bela Turk
- Departments of Neurology and Pediatrics, Moser Center for Leukodystrophies, Kennedy Krieger Institute, Johns Hopkins Medical Institutions, Baltimore, MD, United States
| | - Ruben Pagkatipunan
- Department of Rehabilitation, Johns Hopkins Bayview Medical Center, Baltimore, MD, United States
| | - Sera-Kim Huenergard
- Department of Rehabilitation, Johns Hopkins Bayview Medical Center, Baltimore, MD, United States
| | - Albert Mears
- Department of Rehabilitation, Johns Hopkins Bayview Medical Center, Baltimore, MD, United States
| | - Jee Bang
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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7
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Olfati N, Shoeibi A, Litvan I. Clinical Spectrum of Tauopathies. Front Neurol 2022; 13:944806. [PMID: 35911892 PMCID: PMC9329580 DOI: 10.3389/fneur.2022.944806] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 06/20/2022] [Indexed: 11/20/2022] Open
Abstract
Tauopathies are both clinical and pathological heterogeneous disorders characterized by neuronal and/or glial accumulation of misfolded tau protein. It is now well understood that every pathologic tauopathy may present with various clinical phenotypes based on the primary site of involvement and the spread and distribution of the pathology in the nervous system making clinicopathological correlation more and more challenging. The clinical spectrum of tauopathies includes syndromes with a strong association with an underlying primary tauopathy, including Richardson syndrome (RS), corticobasal syndrome (CBS), non-fluent agrammatic primary progressive aphasia (nfaPPA)/apraxia of speech, pure akinesia with gait freezing (PAGF), and behavioral variant frontotemporal dementia (bvFTD), or weak association with an underlying primary tauopathy, including Parkinsonian syndrome, late-onset cerebellar ataxia, primary lateral sclerosis, semantic variant PPA (svPPA), and amnestic syndrome. Here, we discuss clinical syndromes associated with various primary tauopathies and their distinguishing clinical features and new biomarkers becoming available to improve in vivo diagnosis. Although the typical phenotypic clinical presentations lead us to suspect specific underlying pathologies, it is still challenging to differentiate pathology accurately based on clinical findings due to large phenotypic overlaps. Larger pathology-confirmed studies to validate the use of different biomarkers and prospective longitudinal cohorts evaluating detailed clinical, biofluid, and imaging protocols in subjects presenting with heterogenous phenotypes reflecting a variety of suspected underlying pathologies are fundamental for a better understanding of the clinicopathological correlations.
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Affiliation(s)
- Nahid Olfati
- Department of Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- UC San Diego Department of Neurosciences, Parkinson and Other Movement Disorder Center, San Diego, CA, United States
| | - Ali Shoeibi
- Department of Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Irene Litvan
- UC San Diego Department of Neurosciences, Parkinson and Other Movement Disorder Center, San Diego, CA, United States
- *Correspondence: Irene Litvan
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8
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Sorrento GU, Soto MCS, Espay AJ, Bloem BR, Fasano A. Conditions Associated with On-State Freezing of Gait. Mov Disord Clin Pract 2022; 9:558-559. [PMID: 35586522 PMCID: PMC9092752 DOI: 10.1002/mdc3.13445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 03/06/2022] [Accepted: 03/16/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Gianluca U. Sorrento
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health NetworkTorontoOntarioCanada
| | - Maria Carolina Sepulveda Soto
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health NetworkTorontoOntarioCanada
- Division of NeurologyUniversity of TorontoTorontoOntarioCanada
| | - Alberto J. Espay
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement DisordersDepartment of Neurology, University of CincinnatiCincinnatiOhioUSA
| | - Bastiaan R. Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourDepartment of NeurologyNijmegenthe Netherlands
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health NetworkTorontoOntarioCanada
- Division of NeurologyUniversity of TorontoTorontoOntarioCanada
- Krembil Brain InstituteTorontoOntarioCanada
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9
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Ferrazzoli D, Ortelli P, Iansek R, Volpe D. Rehabilitation in movement disorders: From basic mechanisms to clinical strategies. HANDBOOK OF CLINICAL NEUROLOGY 2022; 184:341-355. [PMID: 35034747 DOI: 10.1016/b978-0-12-819410-2.00019-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Movement disorders encompass a variety of conditions affecting the nervous system at multiple levels. The pathologic processes underlying movement disorders alter the normal neural functions and could lead to aberrant neuroplastic changes and to clinical phenomenology that is not expressed only through mere motor symptoms. Given this complexity, the responsiveness to pharmacologic and surgical therapies is often disappointing. Growing evidence supports the efficacy of neurorehabilitation for the treatment of movement disorders. Specific form of training involving both goal-based practice and aerobic training could drive and modulate neuroplasticity in order to restore the circuitries dysfunctions and to achieve behavioral gains. This chapter provides an overview of the alterations expressed in some movement disorders in terms of clinical signs and symptoms and plasticity, and suggests which ones and why tailored rehabilitation strategies should be adopted for the management of the different movement disorders.
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Affiliation(s)
- Davide Ferrazzoli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy; Department of Parkinson's Disease, Fresco Parkinson Center, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital-Gravedona ed Uniti, Como, Italy
| | - Paola Ortelli
- Department of Parkinson's Disease, Fresco Parkinson Center, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital-Gravedona ed Uniti, Como, Italy; Department of Parkinson's Disease, Fresco Parkinson Center, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital-Gravedona ed Uniti, Como, Italy
| | - Robert Iansek
- Clinical Research Centre for Movement Disorders and Gait, National Parkinson Foundation Center of Excellence, Monash Health, Cheltenham, VIC, Australia; School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Daniele Volpe
- Department of Rehabilitation, Fresco Parkinson Center, Villa Margherita, S. Stefano Riabilitazione, Vicenza, Italy
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10
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Ali F, Loushin SR, Botha H, Josephs KA, Whitwell JL, Kaufman K. Laboratory based assessment of gait and balance impairment in patients with progressive supranuclear palsy. J Neurol Sci 2021; 429:118054. [PMID: 34461552 PMCID: PMC8489851 DOI: 10.1016/j.jns.2021.118054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/27/2021] [Accepted: 08/23/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Gait and balance abnormalities are a significant source of morbidity and mortality in progressive supranuclear palsy (PSP). Gait impairment in PSP is primarily assessed clinically on exam or with the use of rating scales. Three dimensional video based gait and balance analysis performed in a laboratory setting is a highly accurate method of motion analysis (Wren et al., 2020), however limited data is available in patients with PSP. RESEARCH QUESTION In this study we assess the objective features of postural control, kinematics, kinetic and temporal-spatial gait metrics in PSP, using three-dimensional video motion analysis in a laboratory setting compared to normal controls. METHODS Three-dimensional motion was captured using a 10-camera motion capture system, 41 body markers and ground embedded force plates in 16 patients with PSP patients and compared to motorically normal controls. RESULTS Spatiotemporal, kinematic, and kinetic gait measures effectively differentiated patients with PSP from controls. Patients had slower gait velocity, lower cadence, increased double support time and abnormal antero-posterior sway. Joint kinematics and kinetics were reduced and showed less variation among patients with PSP compared to controls which is suggestive of bradykinesia. Objective gait measures of abnormality correlated with clinical disease severity. Postural sway metrics distinguished PSP from controls and captured gait imbalance. SIGNIFICANCE Objective measures of gait and balance abnormalities in patients with PSP provide an outcome measure that can be potentially used for early disease detection, in clinical trials and to validate portable motion capture devices in the future.
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Affiliation(s)
- Farwa Ali
- Department of Neurology, Rochester, MN, United States of America.
| | - Stacy R Loushin
- Department of Orthopedic Surgery, Rochester, MN, United States of America
| | - Hugo Botha
- Department of Neurology, Rochester, MN, United States of America
| | - Keith A Josephs
- Department of Neurology, Rochester, MN, United States of America
| | - Jennifer L Whitwell
- Department of Radiology, Mayo Clinic Rochester, Rochester, MN, United States of America
| | - Kenton Kaufman
- Department of Orthopedic Surgery, Rochester, MN, United States of America
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11
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Sintini I, Kaufman K, Botha H, Martin PR, Loushin SR, Senjem ML, Reid RI, Schwarz CG, Jack CR, Lowe VJ, Josephs KA, Whitwell JL, Ali F. Neuroimaging correlates of gait abnormalities in progressive supranuclear palsy. Neuroimage Clin 2021; 32:102850. [PMID: 34655905 PMCID: PMC8527041 DOI: 10.1016/j.nicl.2021.102850] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/24/2021] [Accepted: 10/02/2021] [Indexed: 11/20/2022]
Abstract
Progressive supranuclear palsy is a neurodegenerative disorder characterized primarily by tau inclusions and neurodegeneration in the midbrain, basal ganglia, thalamus, premotor and frontal cortex. Neurodegenerative change in progressive supranuclear palsy has been assessed using MRI. Degeneration of white matter tracts is evident with diffusion tensor imaging and PET methods have been used to assess brain metabolism or presence of tau protein deposits. Patients with progressive supranuclear palsy present with a variety of clinical syndromes; however early onset of gait impairments and postural instability are common features. In this study we assessed the relationship between multimodal imaging biomarkers (i.e., MRI atrophy, white matter tracts degeneration, flortaucipir-PET uptake) and laboratory-based measures of gait and balance abnormalities in a cohort of nineteen patients with progressive supranuclear palsy, using univariate and multivariate statistical analyses. The PSP rating scale and its gait midline sub-score were strongly correlated to gait abnormalities but not to postural imbalance. Principal component analysis on gait variables identified velocity, stride length, gait stability ratio, length of gait phases and dynamic stability as the main contributors to the first component, which was associated with diffusion tensor imaging measures in the posterior thalamic radiation, external capsule, superior cerebellar peduncle, superior fronto-occipital fasciculus, body and splenium of the corpus callosum and sagittal stratum, with MRI volumes in frontal and precentral regions and with flortaucipir-PET uptake in the precentral gyrus. The main contributor to the second principal component was cadence, which was higher in patients presenting more abnormalities on mean diffusivity: this unexpected finding might be related to compensatory gait strategies adopted in progressive supranuclear palsy. Postural imbalance was the main contributor to the third principal component, which was related to flortaucipir-PET uptake in the left paracentral lobule and supplementary motor area and white matter disruption in the superior cerebellar peduncle, putamen, pontine crossing tract and corticospinal tract. A partial least square model identified flortaucipir-PET uptake in midbrain, basal ganglia and thalamus as the main correlate of speed and dynamic component of gait in progressive supranuclear palsy. Although causality cannot be established in this analysis, our study sheds light on neurodegeneration of brain regions and white matter tracts that underlies gait and balance impairment in progressive supranuclear palsy.
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Affiliation(s)
- Irene Sintini
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA.
| | - Kenton Kaufman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Peter R Martin
- Department of Health Science Research, Mayo Clinic, Rochester, MN 55905, USA
| | - Stacy R Loushin
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Matthew L Senjem
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA; Department of Information Technology, Mayo Clinic, Rochester MN 55905, USA
| | - Robert I Reid
- Department of Information Technology, Mayo Clinic, Rochester MN 55905, USA
| | | | - Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Keith A Josephs
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Farwa Ali
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
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12
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Pereira CR, Criado MB, Machado J, Pereira CT, Santos MJ. Acute effects of acupuncture in balance and gait of Parkinson disease patients - A preliminary study. Complement Ther Clin Pract 2021; 45:101479. [PMID: 34543873 DOI: 10.1016/j.ctcp.2021.101479] [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: 11/08/2020] [Revised: 08/08/2021] [Accepted: 08/28/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Balance and gait disorders are relevant symptoms in the quality of life of Parkinson's patients. Currently, there is no therapy to reverse or treat this condition. Acupuncture treatment is believed to improve motor ability through the cortico-basal-thalamus-cortical-ganglia. AIM To investigate qualitatively the acute effect of acupuncture on balance and gait in Parkinson's disease in 7 patients. METHODS This is a randomized and controlled crossover study. The same individual patient was part of both, experimental (real acupuncture) and control group (false acupuncture/sham), and the sequence was randomized. Balance and gait parameters were measured at two different moments, before and after treatment, using four force platforms as well as the collection of 3D markers positions taken by 11 cameras. Images were analyzed using Qualisys Track Manager software that let us extract data related to the quality of gait and balance. RESULTS Statistically significant differences were found in gait speed (p = 0.016), gait cadence (p = 0.006), support base width (p = 0.0001), medio-lateral oscillation (p = 0.017), left-right step length (p = 0.0002), and stride length: right-right (p = 0.0000) and left-left (p = 0.0018), time of left support phase (p = 0.029), right support phase (p = 0.025) and double support phase (p = 0.015), between the initial and final moments for the experimental group. Differences in right-left stride length were found for both groups. CONCLUSION Our results suggest that the acupuncture protocol used objectively could improve gait in Parkinson disease patients. A deep research involving a statistical evaluation supported on a larger number of voluntaries should be accomplished to confirming these promising preliminary results.
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Affiliation(s)
- Catarina Ramos Pereira
- ICBAS-Abel Salazar Institute for Biomedical Sciences, University of Porto, Portugal; CBSin - Center of Integrative Health Biosciences, Porto, Portugal.
| | - Maria Begoña Criado
- IINFACTS - Institute of Research and Advance Formation in Health Sciences and Technology, Paredes, Portugal; CBSin - Center of Integrative Health Biosciences, Porto, Portugal
| | - Jorge Machado
- ICBAS-Abel Salazar Institute for Biomedical Sciences, University of Porto, Portugal; CBSin - Center of Integrative Health Biosciences, Porto, Portugal; LABIOMEP - Porto Biomechanics Laboratory, University of Porto, Portugal
| | - Carlos Trigo Pereira
- ICBAS-Abel Salazar Institute for Biomedical Sciences, University of Porto, Portugal
| | - Maria João Santos
- ICBAS-Abel Salazar Institute for Biomedical Sciences, University of Porto, Portugal; Escola Superior de Saúde, Piaget Institute, Vila Nova de Gaia, Portugal
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13
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Picillo M, Ricciardi C, Tepedino MF, Abate F, Cuoco S, Carotenuto I, Erro R, Ricciardelli G, Russo M, Cesarelli M, Barone P, Amboni M. Gait Analysis in Progressive Supranuclear Palsy Phenotypes. Front Neurol 2021; 12:674495. [PMID: 34177779 PMCID: PMC8224759 DOI: 10.3389/fneur.2021.674495] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/29/2021] [Indexed: 11/13/2022] Open
Abstract
The objective of the present study was to describe gait parameters of progressive supranuclear palsy (PSP) phenotypes at early stage verifying the ability of gait analysis in discriminating between disease phenotypes and between the other variant syndromes of PSP (vPSP) and Parkinson's disease (PD). Nineteen PSP (10 PSP-Richardson's syndrome, five PSP-parkinsonism, and four PSP-progressive gait freezing) and nine PD patients performed gait analysis in single and dual tasks. Although phenotypes showed similar demographic and clinical variables, Richardson's syndrome presented worse cognitive functions. Gait analysis demonstrated worse parameters in Richardson's syndrome compared with the vPSP. The overall diagnostic accuracy of the statistical model during dual task was almost 90%. The correlation analysis showed a significant relationship between gait parameters and visuo-spatial, praxic, and attention abilities in PSP-Richardson's syndrome only. vPSP presented worse gait parameters than PD. Richardson's syndrome presents greater gait dynamic instability since the earliest stages than other phenotypes. Computerized gait analysis can differentiate between PSP phenotypes and between vPSP and PD.
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Affiliation(s)
- Marina Picillo
- Department of Medicine, Surgery and Dentistry, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Fisciano, Italy
| | - Carlo Ricciardi
- Department of Electrical Engineering and Information Technology, University of Naples "Federico II", Naples, Italy.,Istituti Clinici Scientifici Maugeri Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Telese Terme, Italy
| | - Maria Francesca Tepedino
- Department of Medicine, Surgery and Dentistry, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Fisciano, Italy
| | - Filomena Abate
- Department of Medicine, Surgery and Dentistry, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Fisciano, Italy
| | - Sofia Cuoco
- Department of Medicine, Surgery and Dentistry, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Fisciano, Italy
| | - Immacolata Carotenuto
- Department of Medicine, Surgery and Dentistry, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Fisciano, Italy
| | - Roberto Erro
- Department of Medicine, Surgery and Dentistry, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Fisciano, Italy
| | - Gianluca Ricciardelli
- Department of Medicine, Azienda Ospedaliera Universitaria OO. RR. San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Michela Russo
- Department of Electrical Engineering and Information Technology, University of Naples "Federico II", Naples, Italy
| | - Mario Cesarelli
- Department of Electrical Engineering and Information Technology, University of Naples "Federico II", Naples, Italy.,Istituti Clinici Scientifici Maugeri Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Telese Terme, Italy
| | - Paolo Barone
- Department of Medicine, Surgery and Dentistry, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Fisciano, Italy
| | - Marianna Amboni
- Department of Medicine, Surgery and Dentistry, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Fisciano, Italy.,Istituto di Diagnosi e Cura (IDC) Hermitage-Capodimonte, Naples, Italy
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14
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Amboni M, Ricciardi C, Picillo M, De Santis C, Ricciardelli G, Abate F, Tepedino MF, D'Addio G, Cesarelli G, Volpe G, Calabrese MC, Cesarelli M, Barone P. Gait analysis may distinguish progressive supranuclear palsy and Parkinson disease since the earliest stages. Sci Rep 2021; 11:9297. [PMID: 33927317 PMCID: PMC8084977 DOI: 10.1038/s41598-021-88877-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/16/2021] [Indexed: 12/22/2022] Open
Abstract
Progressive supranuclear palsy (PSP) is a rare and rapidly progressing atypical parkinsonism. Albeit existing clinical criteria for PSP have good specificity and sensitivity, there is a need for biomarkers able to capture early objective disease-specific abnormalities. This study aimed to identify gait patterns specifically associated with early PSP. The study population comprised 104 consecutively enrolled participants (83 PD and 21 PSP patients). Gait was investigated using a gait analysis system during normal gait and a cognitive dual task. Univariate statistical analysis and binary logistic regression were used to compare all PD patients and all PSP patients, as well as newly diagnosed PD and early PSP patients. Gait pattern was poorer in PSP patients than in PD patients, even from early stages. PSP patients exhibited reduced velocity and increased measures of dynamic instability when compared to PD patients. Application of predictive models to gait data revealed that PD gait pattern was typified by increased cadence and longer cycle length, whereas a longer stance phase characterized PSP patients in both mid and early disease stages. The present study demonstrates that quantitative gait evaluation clearly distinguishes PSP patients from PD patients since the earliest stages of disease. First, this might candidate gait analysis as a reliable biomarker in both clinical and research setting. Furthermore, our results may offer speculative clues for conceiving early disease-specific rehabilitation strategies.
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Affiliation(s)
- Marianna Amboni
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Via Salvador Allende, 43, 84081, Baronissi, SA, Italy. .,IDC Hermitage-Capodimonte, Naples, Italy.
| | - Carlo Ricciardi
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.,Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Marina Picillo
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Via Salvador Allende, 43, 84081, Baronissi, SA, Italy
| | - Chiara De Santis
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Via Salvador Allende, 43, 84081, Baronissi, SA, Italy
| | - Gianluca Ricciardelli
- Azienda Ospedaliera Universitaria OO. RR. San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Filomena Abate
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Via Salvador Allende, 43, 84081, Baronissi, SA, Italy
| | - Maria Francesca Tepedino
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Via Salvador Allende, 43, 84081, Baronissi, SA, Italy
| | | | - Giuseppe Cesarelli
- Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy.,Department of Chemical, Materials and Production Engineering, University of Naples "Federico II", Naples, Italy
| | - Giampiero Volpe
- Azienda Ospedaliera Universitaria OO. RR. San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Maria Consiglia Calabrese
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Via Salvador Allende, 43, 84081, Baronissi, SA, Italy
| | - Mario Cesarelli
- Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy.,Department of Electrical Engineering and Information Technology, University of Naples "Federico II", Naples, Italy
| | - Paolo Barone
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Via Salvador Allende, 43, 84081, Baronissi, SA, Italy
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15
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Zanardi APJ, da Silva ES, Costa RR, Passos-Monteiro E, Dos Santos IO, Kruel LFM, Peyré-Tartaruga LA. Gait parameters of Parkinson's disease compared with healthy controls: a systematic review and meta-analysis. Sci Rep 2021; 11:752. [PMID: 33436993 PMCID: PMC7804291 DOI: 10.1038/s41598-020-80768-2] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 12/28/2020] [Indexed: 12/15/2022] Open
Abstract
We systematically reviewed observational and clinical trials (baseline) studies examining differences in gait parameters between Parkinson’s disease (PD) in on-medication state and healthy control. Four electronic databases were searched (November-2018 and updated in October-2020). Independent researchers identified studies that evaluated gait parameters measured quantitatively during self-selected walking speed. Risk of bias was assessed using an instrument proposed by Downs and Black (1998). Pooled effects were reported as standardized mean differences and 95% confidence intervals using a random-effects model. A total of 72 studies involving 3027 participants (1510 with PD and 1517 health control) met the inclusion criteria. The self-selected walking speed, stride length, swing time and hip excursion were reduced in people with PD compared with healthy control. Additionally, PD subjects presented higher cadence and double support time. Although with a smaller difference for treadmill, walking speed is reduced both on treadmill (.13 m s−1) and on overground (.17 m s−1) in PD. The self-select walking speed, stride length, cadence, double support, swing time and sagittal hip angle were altered in people with PD compared with healthy control. The precise determination of these modifications will be beneficial in determining which intervention elements are most critical in bringing about positive, clinically meaningful changes in individuals with PD (PROSPERO protocol CRD42018113042).
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Affiliation(s)
- Ana Paula Janner Zanardi
- Exercise Research Laboratory, Universidade Federal Do Rio Grande Do Sul, 750 Felizardo St, Porto Alegre, RS, 90690-200, Brazil.,Univel University Center, Cascavel, Brazil
| | - Edson Soares da Silva
- Exercise Research Laboratory, Universidade Federal Do Rio Grande Do Sul, 750 Felizardo St, Porto Alegre, RS, 90690-200, Brazil
| | - Rochelle Rocha Costa
- Exercise Research Laboratory, Universidade Federal Do Rio Grande Do Sul, 750 Felizardo St, Porto Alegre, RS, 90690-200, Brazil
| | - Elren Passos-Monteiro
- Exercise Research Laboratory, Universidade Federal Do Rio Grande Do Sul, 750 Felizardo St, Porto Alegre, RS, 90690-200, Brazil.,Laboratory of PhysioMechanics of Locomotion, Universidade Federal Do Pará, Castanhal, Brazil
| | - Ivan Oliveira Dos Santos
- Exercise Research Laboratory, Universidade Federal Do Rio Grande Do Sul, 750 Felizardo St, Porto Alegre, RS, 90690-200, Brazil
| | - Luiz Fernando Martins Kruel
- Exercise Research Laboratory, Universidade Federal Do Rio Grande Do Sul, 750 Felizardo St, Porto Alegre, RS, 90690-200, Brazil
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16
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Akdal G, Boz H, Kiriş A, Koçoğlu K, Çolakoğlu B, Çakmur R. Balance and gait disturbances and quality of life in patients with idiopathic parkinson's disease and progressive supranuclear palsy. NEUROL SCI NEUROPHYS 2021. [DOI: 10.4103/nsn.nsn_148_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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17
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Celik Y, Stuart S, Woo WL, Godfrey A. Gait analysis in neurological populations: Progression in the use of wearables. Med Eng Phys 2020; 87:9-29. [PMID: 33461679 DOI: 10.1016/j.medengphy.2020.11.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/02/2020] [Accepted: 11/11/2020] [Indexed: 12/19/2022]
Abstract
Gait assessment is an essential tool for clinical applications not only to diagnose different neurological conditions but also to monitor disease progression as it contributes to the understanding of underlying deficits. There are established methods and models for data collection and interpretation of gait assessment within different pathologies. This narrative review aims to depict the evolution of gait assessment from observation and rating scales to wearable sensors and laboratory technologies and provide limitations and possible future directions in the field of gait assessment. In this context, we first present an extensive review of current clinical outcomes and gait models. Then, we demonstrate commercially available wearable technologies with their technical capabilities along with their use in gait assessment studies for various neurological conditions. In the next sections, a descriptive knowledge for existing inertial and EMG based algorithms and a sign based guide that shows the outcomes of previous neurological gait assessment studies are presented. Finally, we state a discussion for the use of wearables in gait assessment and speculate the possible research directions by revealing the limitations and knowledge gaps in the literature.
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Affiliation(s)
- Y Celik
- Department of Computer and Information Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
| | - S Stuart
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
| | - W L Woo
- Department of Computer and Information Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
| | - A Godfrey
- Department of Computer and Information Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK.
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18
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De Vos M, Prince J, Buchanan T, FitzGerald JJ, Antoniades CA. Discriminating progressive supranuclear palsy from Parkinson's disease using wearable technology and machine learning. Gait Posture 2020; 77:257-263. [PMID: 32078894 DOI: 10.1016/j.gaitpost.2020.02.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 02/05/2020] [Accepted: 02/06/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Progressive supranuclear palsy (PSP), a neurodegenerative conditions may be difficult to discriminate clinically from idiopathic Parkinson's disease (PD). It is critical that we are able to do this accurately and as early as possible in order that future disease modifying therapies for PSP may be deployed at a stage when they are likely to have maximal benefit. Analysis of gait and related tasks is one possible means of discrimination. RESEARCH QUESTION Here we investigate a wearable sensor array coupled with machine learning approaches as a means of disease classification. METHODS 21 participants with PSP, 20 with PD, and 39 healthy control (HC) subjects performed a two minute walk, static sway test, and timed up-and-go task, while wearing an array of six inertial measurement units. The data were analysed to determine what features discriminated PSP from PD and PSP from HC. Two machine learning algorithms were applied, Logistic Regression (LR) and Random Forest (RF). RESULTS 17 features were identified in the combined dataset that contained independent information. The RF classifier outperformed the LR classifier, and allowed discrimination of PSP from PD with 86 % sensitivity and 90 % specificity, and PSP from HC with 90 % sensitivity and 97 % specificity. Using data from the single lumbar sensor only resulted in only a modest reduction in classification accuracy, which could be restored using 3 sensors (lumbar, right arm and foot). However for maximum specificity the full six sensor array was needed. SIGNIFICANCE A wearable sensor array coupled with machine learning methods can accurately discriminate PSP from PD. Choice of array complexity depends on context; for diagnostic purposes a high specificity is needed suggesting the more complete array is advantageous, while for subsequent disease tracking a simpler system may suffice.
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Affiliation(s)
- Maarten De Vos
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Old Road Campus Research Building, OX3 7DQ, Oxford, UK
| | - John Prince
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Old Road Campus Research Building, OX3 7DQ, Oxford, UK
| | | | - James J FitzGerald
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, OX3 9DU, UK; Nuffield Department of Clinical Neurosciences, NeuroMetrology Lab, University of Oxford, Oxford, OX3 9DU, UK
| | - Chrystalina A Antoniades
- Nuffield Department of Clinical Neurosciences, NeuroMetrology Lab, University of Oxford, Oxford, OX3 9DU, UK.
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19
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Neuronal oscillations of the pedunculopontine nucleus in progressive supranuclear palsy: Influence of levodopa and movement. Clin Neurophysiol 2020; 131:414-419. [DOI: 10.1016/j.clinph.2019.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 11/06/2019] [Accepted: 11/15/2019] [Indexed: 11/13/2022]
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20
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Takamatsu Y, Matsuda N, Aiba I. The combination of short-step and wide-based gait is a gait characteristic in progressive supranuclear palsy: a retrospective, cross-sectional study. Eur Geriatr Med 2019; 10:809-815. [PMID: 34652693 DOI: 10.1007/s41999-019-00211-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 05/29/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Like Parkinson's disease (PD), gait disturbance is a major problem in progressive supranuclear palsy (PSP). Despite limited studies investigating the gait characteristics, we hypothesize that they differ from PD owing to the involvement of different brain lesions. Hence, this study aims to investigate the gait characteristics in patients with PSP by comparing with healthy older adults and patients with PD. METHODS We identified 27 PSP patients, 25 PD patients, and 25 neurologically healthy older persons. Using a device that detected the distribution of foot pressure during walking, we analyzed gait variables and measured the walking speed (cm/s), cadence (steps/min), step length (cm), step width (cm), foot angle (°), and gait cycle time (s). Additionally, we calculated the coefficient of variation (CV, %) on walking speed and cadence and analyzed the gait characteristics by the PSP subtypes. RESULTS In PSP and PD, the walking speed was slower and the step length was shorter than healthy controls. The CV of cadence in PSP was higher than healthy controls and PD. In PSP, the step width and foot angle were higher than healthy controls and PD. The gait cycle time was longer in PSP and PD than healthy controls. PSP with progressive freezing gait tended to display a faster walking speed. Furthermore, PSP with parkinsonism-resembling idiopathic PD tended to exhibit the larger step width and foot angle compared with PSP-Richardson's syndrome. CONCLUSION This study suggests that the gait of PSP was unstable with parkinsonism and wide-based, which might be similar to combining features of PD and cerebellar disorders.
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Affiliation(s)
- Yasuyuki Takamatsu
- Department of Rehabilitation, National Hospital Organization, Higashinagoya National Hospital, 5-101 Umemorizaka, Meito-ku, Nagoya, Aichi, 465-8620, Japan.
- Department of Rehabilitation Science, Faculty of Health Sciences, Hokkaido University, Kita 12 Nishi 5, Kita-ku, Sapporo, Hokkaido, 060-0812, Japan.
| | - Naomi Matsuda
- Department of Rehabilitation, National Hospital Organization, Higashinagoya National Hospital, 5-101 Umemorizaka, Meito-ku, Nagoya, Aichi, 465-8620, Japan
| | - Ikuko Aiba
- Department of Neurology, National Hospital Organization, Higashinagoya National Hospital, 5-101 Umemorizaka, Meito-ku, Nagoya, Aichi, 465-8620, Japan
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21
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Gilmore G, Gouelle A, Adamson MB, Pieterman M, Jog M. Forward and backward walking in Parkinson disease: A factor analysis. Gait Posture 2019; 74:14-19. [PMID: 31437733 DOI: 10.1016/j.gaitpost.2019.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/09/2019] [Accepted: 08/08/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Forward and backward walking are both impaired in Parkinson disease (PD). In this study, an exploratory factor analysis was performed to investigate the relationship between forward and backward walking in PD. RESEARCH QUESTION Given the difference in levodopa response between forward and backward walking, what is the additive value of testing backwards walking in a clinical setting. METHODS Sixty-two patients with PD (65.29 ± 7.17 yrs, UPDRS OFF = 29.68 ± 9.88, UPDRS ON = 16.40 ± 8.21) and eleven healthy age-matched controls (63.09 ± 8.09 yrs) were recruited. PD participants completed forward (F) and backward (B) walking tasks on a 6.1 m instrumented walkway (OFF and ON levodopa). Factor analysis was used to derive models for both walking tasks/medication states. RESULTS In both OFF and ON, four factors were identified: Variability (OFF: F = 30.0%, B = 17.8%, ON: F = 21.6%, B = 25.0%), Rhythm (OFF: F = 14.5%, B = 17.0%, ON: F = 17.4%, B = 19.0%), Asymmetry (OFF: F = 13.7%, B = 14.3%, ON: F = 16.1%, B = 15.2%), and Pace (OFF: F = 12.2%, B = 17.0%, ON: F = 13.9%, B = 8.7%). In the ON state, a fifth factor was identified: Posture (ON: F = 3.8%, B = 7.7%). SIGNIFICANCE This study demonstrates the similarity in gait domain factors in both forward and backward walking. While domains of gait are similar in both walking tasks, levodopa response is reduced in backward walking. This could be a result of the increased complexity of backward walking. This study provides a normative dataset that can be used when assessing forward and backward walking in individuals with PD.
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Affiliation(s)
- Greydon Gilmore
- School of Biomedical Engineering, Western University, London, Canada; Department of Clinical Neurological Sciences, University Hospital, London, Canada.
| | - Arnaud Gouelle
- Gait and Balance Academy, ProtoKinetics, Havertown, PA, United States; Laboratory Performance, Sante, Metrologie, Societe (PSMS), UFR STAPS, Reims, France
| | - Mitchell B Adamson
- Department of Clinical Neurological Sciences, University Hospital, London, Canada
| | - Marcus Pieterman
- Department of Clinical Neurological Sciences, University Hospital, London, Canada
| | - Mandar Jog
- School of Biomedical Engineering, Western University, London, Canada; Department of Clinical Neurological Sciences, University Hospital, London, Canada
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22
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Galazky I, Kaufmann J, Voges J, Hinrichs H, Heinze HJ, Sweeney-Reed CM. Neuronal spiking in the pedunculopontine nucleus in progressive supranuclear palsy and in idiopathic Parkinson's disease. J Neurol 2019; 266:2244-2251. [PMID: 31155683 DOI: 10.1007/s00415-019-09396-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/20/2019] [Accepted: 05/22/2019] [Indexed: 12/24/2022]
Abstract
The pedunculopontine nucleus (PPN) is engaged in posture and gait control, and neuronal degeneration in the PPN has been associated with Parkinsonian disorders. Clinical outcomes of deep brain stimulation of the PPN in idiopathic Parkinson's disease (IPD) and progressive supranuclear palsy (PSP) differ, and we investigated whether the PPN is differentially affected in these conditions. We had the rare opportunity to record continuous electrophysiological data intraoperatively in 30 s blocks from single microelectrode contacts implanted in the PPN in six PSP patients and three IPD patients during rest, passive movement, and active movement. Neuronal spikes were sorted according to shape using a wavelet-based clustering approach to enable comparisons between individual neuronal firing rates in the two disease states. The action potential widths showed a bimodal distribution consistent with previous findings, suggesting spikes from noncholinergic (likely glutamatergic) and cholinergic neurons. A higher PPN spiking rate of narrow action potentials was observed in the PSP than in the IPD patients when pooled across all three conditions (Wilcoxon rank sum test: p = 0.0141). No correlation was found between firing rate and disease severity or duration. The firing rates were higher during passive movement than rest and active movement in both groups, but the differences between conditions were not significant. PSP and IPD are believed to represent distinct disease processes, and our findings that the neuronal firing rates differ according to disease state support the proposal that pathological processes directly involving the PPN may be more pronounced in PSP than IPD.
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Affiliation(s)
- I Galazky
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - J Kaufmann
- Department of Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany
- Departments of Neurology and Stereotactic Neurosurgery, Otto-von-Guericke University, Magdeburg, Germany
| | - J Voges
- Department of Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany
- Department of Stereotactic Neurosurgery, Otto-von-Guericke University, Magdeburg, Germany
| | - H Hinrichs
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
- Department of Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany
- German Center for Neurodegenerative Disease (DZNE), Magdeburg, Germany
- Forschungscampus STIMULATE, Otto-von-Guericke University, Magdeburg, Germany
| | - H-J Heinze
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
- Department of Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany
- German Center for Neurodegenerative Disease (DZNE), Magdeburg, Germany
| | - C M Sweeney-Reed
- Neurocybernetics and Rehabilitation, Departments of Neurology and Stereotactic Neurosurgery, Otto-Von-Guericke University, Magdeburg, Germany.
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Lindemann U. Spatiotemporal gait analysis of older persons in clinical practice and research : Which parameters are relevant? Z Gerontol Geriatr 2019; 53:171-178. [PMID: 30770991 DOI: 10.1007/s00391-019-01520-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 01/25/2019] [Accepted: 01/31/2019] [Indexed: 01/01/2023]
Abstract
For older persons walking is a basic activity of daily life which characterizes the person's functional mobility. Therefore, the improvement of walking performance is a major clinical outcome during geriatric rehabilitation. Furthermore, walking performance is relevant for several geriatric research issues. Quantitative gait analysis can describe walking performance in detail. Besides gait speed, various qualitative parameters related to different aspects of walking performance, such as symmetry, regularity, coordination, dynamic balance and foot movement during the swing phase, can serve as outcome parameters in geriatric research and in clinical practice. Clinicians and researchers have to decide which parameters are appropriate to be used as relevant outcome parameters in the investigated person or group of persons.
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Affiliation(s)
- Ulrich Lindemann
- Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany.
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24
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Ambrus M, Sanchez JA, Fernandez-Del-Olmo M. Walking on a treadmill improves the stride length-cadence relationship in individuals with Parkinson's disease. Gait Posture 2019; 68:136-140. [PMID: 30476690 DOI: 10.1016/j.gaitpost.2018.11.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 09/03/2018] [Accepted: 11/17/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The gait pattern in Parkinson´s disease (PD) is characterized by a deficit in the internal regulation of stride length (SL), while the control of cadence (Cad) remains intact. The use of the treadmill as a gait rehabilitation tool has provided novel options for treatment of gait impairments in PD. However, it remains unclear whether walking on the treadmill changes the stride length-cadence relationship (SLCrel) in PD. The purpose of the present study was to analyze the SLCrel in PD subjects walking on a treadmill vs. overground, and to further compare the SLCrel to that of age-matched healthy subjects. METHODS Fifteen PD subjects and fifteen age-matched controls walked overground and on a treadmill at five different self-selected speeds. Gait speed, SL and Cad were recorded at each self-selected speed. A linear regression analysis was conducted to explore the SLCrel and to determine the slope and intercept for each participant. RESULTS PD subjects showed a lower intercept than control subjects when walking both overground and on a treadmill (F = 8.51, p = 0.007). In comparison with walking overground, walking on a treadmill resulted in a significant increase in the intercept in both PD and control groups (F = 12.17, p = 0.002). There were no significant differences in the slope of the SLCrel. CONCLUSION PD subjects are able to improve the internal regulation of SL when walking on a treadmill. Our results confirm the potential therapeutic effects of treadmill training for gait rehabilitation in PD and suggest that the mechanisms underlying the positive effects of treadmill training on PD subjects are sustained.
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Affiliation(s)
- M Ambrus
- Departamento de Educacion Fisica e Deportiva, Facultade de Ciencias do Deporte e a Educacion Fisica, Universidade da Coruna, Av. Ernesto Che Guevara 121, Pazos-Lians, 15179, Oleiros, A Coruna, Spain.
| | - J A Sanchez
- Departamento de Educacion Fisica e Deportiva, Facultade de Ciencias do Deporte e a Educacion Fisica, Universidade da Coruna, Av. Ernesto Che Guevara 121, Pazos-Lians, 15179, Oleiros, A Coruna, Spain.
| | - M Fernandez-Del-Olmo
- Departamento de Educacion Fisica e Deportiva, Facultade de Ciencias do Deporte e a Educacion Fisica, Universidade da Coruna, Av. Ernesto Che Guevara 121, Pazos-Lians, 15179, Oleiros, A Coruna, Spain.
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25
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MacLaren DAA, Ljungberg TL, Griffin ME, Clark SD. Pedunculopontine tegmentum cholinergic loss leads to a progressive decline in motor abilities and neuropathological changes resembling progressive supranuclear palsy. Eur J Neurosci 2018; 48:3477-3497. [PMID: 30339310 DOI: 10.1111/ejn.14212] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 08/28/2018] [Accepted: 09/27/2018] [Indexed: 11/28/2022]
Abstract
Progressive supranuclear palsy (PSP) is the most common atypical Parkinsonism. Although PSP shares some symptomology with Parkinson's disease (PD), PSP has a different underlying pathology characterized by tau aggregation. Furthermore, PSP sufferers respond poorly to PD medications and there are no effective alternative therapeutics. The development of both palliative and disease altering therapeutics has been hampered by the lack of an animal model that displays relevant PSP-like pathology and behavioral deficits. Previously, our lab found that in rats the selective removal of cholinergic pedunculopontine neurons (whose axonal projections overlap with areas of PSP pathology), mimics the extensive loss of cholinergic pedunculopontine neurons seen in PSP, and produces a unique PSP-like combination of deficits in: startle reflex, attention, and motor function. The present study extends those findings by allowing the lesion to incubate for over a year and compares behavioral and post-mortem pathology of pedunculopontine-cholinergic-lesioned and sham-lesioned rats. There was an early startle reflex deficit which did not improve over time. Progressive declines in motor function developed over the course of the year, including an increase in the number of "slips" while navigating various beams and poorly coordinated transitions from an elevated platform into homecages. Histological analysis discovered that the loss off cholinergic pedunculopontine neurons precipitated a significant loss of substantia nigra tyrosine hydroxylase-positive neurons and a significant enlargement of the lateral ventricles. The latter is a distinguishing feature between PSP and PD. This preclinical animal model of PSP has the potential to further our understanding of PSP and aid in the testing of potential therapeutic agents.
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Affiliation(s)
- Duncan A A MacLaren
- Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Trisha L Ljungberg
- Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Meghan E Griffin
- Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Stewart D Clark
- Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
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Talai AS, Ismail Z, Sedlacik J, Boelmans K, Forkert ND. Improved Automatic Morphology-Based Classification of Parkinson's Disease and Progressive Supranuclear Palsy. Clin Neuroradiol 2018; 29:605-614. [PMID: 30218110 DOI: 10.1007/s00062-018-0727-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/25/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The overlapping symptoms of Parkinson's disease (PD) and progressive supranuclear palsy-Richardson's syndrome (PSP-RS) often make a correct clinical diagnosis difficult. The volume of subcortical brain structures derived from high-resolution T1-weighted magnetic resonance imaging (MRI) datasets is frequently used for individual level classification of PD and PSP-RS patients. The aim of this study was to evaluate the benefit of including additional morphological features beyond the simple regional volume, as well as clinical features, and morphological features of cortical structures for an automatic classification of PD and PSP-RS patients. MATERIAL AND METHODS A total of 98 high-resolution T1-weighted MRI datasets from 76 PD patients, and 22 PSP-RS patients were available for this study. Using an atlas-based approach, the volume, surface area, and surface-area-to-volume ratio (SA:V) of 21 subcortical and 48 cortical brain regions were calculated and used as features for a support vector machine classification after application of a RELIEF feature selection method. RESULTS The comparison of the classification results suggests that including all three morphological parameters (volume, surface area and SA:V) can considerably improve classification accuracy compared to using volume or surface area alone. Likewise, including clinical patient features in addition to morphological parameters also considerably increases the classification accuracy. In contrast to this, integrating morphological features of other cortical structures did not lead to improved classification accuracy. Using this optimal set-up, an accuracy of 98% was achieved with only one falsely classified PD and one falsely classified PSP-RS patient. CONCLUSION The results of this study suggest that clinical features as well as more advanced morphological features should be used for future computer-aided diagnosis systems to differentiate PD and PSP-RS patients based on morphological parameters.
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Affiliation(s)
- Aron S Talai
- Department of Radiology and Hotchkiss Brain Institute, Faculty of Medicine, University of Calgary, 3330 Hospital Drive NW, AB T2N 4N1, Calgary, Canada
| | - Zahinoor Ismail
- Departments of Psychiatry, Clinical Neurosciences, and Community Health Sciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Jan Sedlacik
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kai Boelmans
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Nils D Forkert
- Department of Radiology and Hotchkiss Brain Institute, Faculty of Medicine, University of Calgary, 3330 Hospital Drive NW, AB T2N 4N1, Calgary, Canada.
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Turcato AM, Godi M, Giardini M, Arcolin I, Nardone A, Giordano A, Schieppati M. Abnormal gait pattern emerges during curved trajectories in high-functioning Parkinsonian patients walking in line at normal speed. PLoS One 2018; 13:e0197264. [PMID: 29750815 PMCID: PMC5947908 DOI: 10.1371/journal.pone.0197264] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 04/30/2018] [Indexed: 12/22/2022] Open
Abstract
Background Several patients with Parkinson´s disease (PD) can walk normally along straight trajectories, and impairment in their stride length and cadence may not be easily discernible. Do obvious abnormalities occur in these high-functioning patients when more challenging trajectories are travelled, such as circular paths, which normally implicate a graded modulation in the duration of the interlimb gait cycle phases? Methods We compared a cohort of well-treated mildly to moderately affected PD patients to a group of age-matched healthy subjects (HS), by deliberately including HS spontaneously walking at the same speed of the patients with PD. All participants performed, in random order: linear and circular walking (clockwise and counter-clockwise) at self-selected speed. By means of pressure-sensitive insoles, we recorded walking speed, cadence, duration of single support, double support, swing phase, and stride time. Stride length-cadence relationships were built for linear and curved walking. Stride-to-stride variability of temporal gait parameters was also estimated. Results Walking speed, cadence or stride length were not different between PD and HS during linear walking. Speed, cadence and stride length diminished during curved walking in both groups, stride length more in PD than HS. In PD compared to HS, the stride length-cadence relationship was altered during curved walking. Duration of the double-support phase was also increased during curved walking, as was variability of the single support, swing phase and double support phase. Conclusion The spatio-temporal gait pattern and variability are significantly modified in well-treated, high-functioning patients with PD walking along circular trajectories, even when they exhibit no changes in speed in straight-line walking. The increased variability of the gait phases during curved walking is an identifying characteristic of PD. We discuss our findings in term of interplay between control of balance and of locomotor progression: the former is challenged by curved trajectories even in high-functioning patients, while the latter may not be critically affected.
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Affiliation(s)
- Anna Maria Turcato
- Division of Physical Medicine and Rehabilitation, ICS Maugeri SPA SB, Institute of Veruno, IRCCS, Veruno, Novara, Italy
| | - Marco Godi
- Division of Physical Medicine and Rehabilitation, ICS Maugeri SPA SB, Institute of Veruno, IRCCS, Veruno, Novara, Italy
- * E-mail:
| | - Marica Giardini
- Division of Physical Medicine and Rehabilitation, ICS Maugeri SPA SB, Institute of Veruno, IRCCS, Veruno, Novara, Italy
| | - Ilaria Arcolin
- Division of Physical Medicine and Rehabilitation, ICS Maugeri SPA SB, Institute of Veruno, IRCCS, Veruno, Novara, Italy
| | - Antonio Nardone
- Centro Studi Attività Motorie, ICS Maugeri SPA SB, Institute of Pavia, IRCCS, Pavia, Italy
- Neurorehabilitation and Spinal Units, ICS Maugeri SPA SB, Institute of Pavia, IRCCS, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Andrea Giordano
- Unit of Bioengineering, ICS Maugeri SPA SB, Institute of Veruno, IRCCS, Veruno, Novara, Italy
| | - Marco Schieppati
- Department of Exercise & Sports Science, International University of Health, Exercise and Sports, LUNEX University, Differdange, Luxembourg
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Tilley E, McLoughlin J, Koblar SA, Doeltgen SH, Stern C, White S, Peters MDJ. Effectiveness of allied health therapy in the symptomatic management of progressive supranuclear palsy: a systematic review. ACTA ACUST UNITED AC 2018; 14:148-95. [PMID: 27532657 DOI: 10.11124/jbisrir-2016-2002352] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Progressive supranuclear palsy (PSP) is an adult onset neurodegenerative condition associated with mobility, balance, speech, swallowing, vision and cognitive changes. The condition is diagnosed using the National Institute for Neurological Disorders and Stroke (NINDS) and the Society of Progressive Supranuclear Palsy (SPSP) criteria. Therapeutic interventions for PSP are important, and a healthcare team should include a physiotherapist, occupational therapist and speech therapist. Mobility, speech and swallowing problems are commonly experienced, and aspiration pneumonia is the leading cause of death. A preliminary search of the literature has indicated that beyond small case series, there is very little evidence to guide specific allied health therapies in PSP. Many strategies for optimizing independence and function for PSP predominately rely on data extrapolated from the study of Parkinson's disease. OBJECTIVES The objective of this review was to examine the effectiveness of physical, occupational and speech therapy interventions in the symptomatic management of PSP. INCLUSION CRITERIA TYPES OF PARTICIPANTS This review included participants with PSP as per the NINDS and the SPSP criteria, aged over 40 years of age from all community and clinical settings. TYPES OF INTERVENTIONS This review included studies evaluating any allied health therapy that addressed mobility, vision, swallowing, communication or cognitive/neuropsychiatric difficulties experienced by patients with PSP. Studies examining interventions within the current scope of practice, and emerging interventions (non-invasive brain stimulation therapy) were eligible for inclusion. TYPES OF COMPARATOR The effectiveness of interventions of interest was compared with usual care and/or baseline measurements. OUTCOMES Outcomes of interest included the degree of change, or no change, in the symptoms experienced by patients with PSP relevant to allied health. These included difficulties with mobility, vision, swallowing, communication and cognition. TYPES OF STUDIES All types of quantitative study designs published in English from the time of development of the NINDS and the SPSP criteria in 1996-2014 were considered for inclusion. SEARCH STRATEGY A broad range of synonyms for PSP and a three-step search strategy was utilized to identify possible published and unpublished studies from 11 different databases. An initial limited search via MEDLINE (PubMed), CINAHL, Health Informit, PsycINFO, PEDRO, OTSeeker and SpeechBite was undertaken followed by analysis of the text words contained in the title and abstract, and of the index terms used to describe the article. A second search using all identified keywords and index terms was then undertaken across all included databases. Third, hand-searching was conducted and the reference list of all identified reports and articles was searched for additional studies. METHODOLOGICAL QUALITY Critical appraisal was conducted by two independent reviewers using standardized instruments. DATA EXTRACTION Quantitative data were extracted from articles included in the review using standardized data extraction tools. DATA SYNTHESIS As the quantitative articles examined different interventions, pooling of data was not appropriate. Instead, the findings were presented in narrative summary and tabular form. RESULTS Following methodological appraisal, six studies were included in the review. Aside from one small quasi-randomized control study, most studies were small case series and one was a case report. Five of the six studies examined the effectiveness of a range of different physiotherapy rehabilitation programs targeting gait, balance and physical capability, with one study also targeting gaze control. The sixth study examined non-invasive brain stimulation in improving gait and midline symptoms in PSP. No studies examined the effectiveness of occupational therapy or speech therapy interventions in PSP. CONCLUSIONS Research into the effectiveness of allied health therapeutic interventions for PSP symptoms is in its infancy. This review found preliminary evidence to support the use of various physiotherapy rehabilitation programs to improve balance, gait and gaze control in people affected by PSP. Further research is urgently required to identify effective interventions to manage mobility, vision, swallowing, communication and cognitive/neuropsychiatric symptoms associated with this devastating condition.
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Affiliation(s)
- Erica Tilley
- 1The Joanna Briggs Institute, Faculty of Health Sciences, The University of Adelaide, South Australia, Australia 2Faculty of Medicine, School of Health Sciences, Nursing and Health Sciences, Flinders University, South Australia, Australia 3Faculty of Health Sciences, School of Medicine, University of Adelaide, South Australia, Australia
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Rehabilitation in progressive supranuclear palsy: Effectiveness of two multidisciplinary treatments. PLoS One 2017; 12:e0170927. [PMID: 28158197 PMCID: PMC5291505 DOI: 10.1371/journal.pone.0170927] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 01/09/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND to date, there are no medical or surgical treatments for progressive supranuclear palsy (PSP). It is possible to speculate that patients with PSP could benefit from rehabilitative treatments designed for Parkinson's disease, including the use of robot-assisted walking training. OBJECTIVE to evaluate whether the use of the robotic device Lokomat® is superior in PSP patients to the use of treadmill with visual cues and auditory feedbacks (treadmill-plus) in the context of an aerobic, multidisciplinary, intensive, motor-cognitive and goal-based rehabilitation treatment (MIRT) conceived for Parkinsonian patients. METHODS we enrolled twenty-four PSP patients. Twelve subjects underwent a 4-week MIRT exploiting the use of the treadmill-plus (MIRT group). Twelve subjects underwent the same treatment, but replacing the treadmill-plus with Lokomat® (MIRT-Lokomat group). Subjects were evaluated with clinical and functional scales at admission and discharge. The primary outcomes were the total PSP Rating Scale (PSPRS) score and its "limb" and "gait" sub-scores. Secondary outcomes were Berg Balance Scale (BBS), Six Minutes Walking test (6MWT) and the number of falls. RESULTS total PSPRS, PSPRS-gait sub-score, BBS, 6MWT and number of falls improved significantly in both groups (p ≤ 0.003 all, except 6MWT, p = 0.032 and p = 0.018 in MIRT-Lokomat and MIRT group respectively). The PSPRS-limb sub-score improved significantly only in the MIRT group (p = 0.002). A significant difference between groups was observed only for total PSPRS, indicating a slightly better improvement for patients in the MIRT group (p = 0.047). No differences between groups were revealed for the other outcomes, indicating that the effect of rehabilitation was similar in both groups. CONCLUSIONS Lokomat® training, in comparison with treadmill-plus training, does not provide further benefits in PSP patients undergoing MIRT. Our findings suggest the usefulness of an aerobic, multidisciplinary, intensive, motor-cognitive and goal-based approach for the rehabilitation of patients suffering from such a complex disease as PSP. TRIAL REGISTRATION This trial was registered on ClinicalTrials.gov, NCT02109393.
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Disturbances of automatic gait control mechanisms in higher level gait disorder. Gait Posture 2016; 48:47-51. [PMID: 27477707 DOI: 10.1016/j.gaitpost.2016.04.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 03/21/2016] [Accepted: 04/26/2016] [Indexed: 02/02/2023]
Abstract
The underlying mechanisms responsible for the gait changes in frontal gait disorder (FGD), a form of higher level gait disorders, are poorly understood. We investigated the relationship between stride length and cadence (SLCrel) in people with FGD (n=15) in comparison to healthy older adults (n=21) to improve our understanding of the changes to gait in FGD. Gait data was captured using an electronic walkway system as participants walked at five self-selected speed conditions: preferred, very slow, slow, fast and very fast. Linear regression was used to determine the strength of the relationship (R(2)), slope and intercept. In the FGD group 9 participants had a strong SLCrel (linear group) (R(2)>0.8) and 6 a weak relationship (R(2)<0.8) (nonlinear group). The linear FGD group did not differ to healthy control for slope (p>0.05) but did have a lower intercept (p<0.001). The linear FGD group modulated gait speed by adjusting stride length and cadence similar to controls whereas the nonlinear FGD participants adjusted stride length but not cadence similar to controls. The non-linear FGD group had greater disturbance to their gait, poorer postural control and greater fear of falling compared to the linear FGD group. Investigation of the SLCrel resulted in new insights into the underlying mechanisms responsible for the gait changes found in FGD. The findings suggest stride length regulation was disrupted in milder FGD but as the disorder worsened, cadence control also became disordered resulting in a break down in the relationship between stride length and cadence.
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31
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Zhao Y, Tseng IC, Heyser CJ, Rockenstein E, Mante M, Adame A, Zheng Q, Huang T, Wang X, Arslan PE, Chakrabarty P, Wu C, Bu G, Mobley WC, Zhang YW, St George-Hyslop P, Masliah E, Fraser P, Xu H. Appoptosin-Mediated Caspase Cleavage of Tau Contributes to Progressive Supranuclear Palsy Pathogenesis. Neuron 2015; 87:963-75. [PMID: 26335643 PMCID: PMC4575284 DOI: 10.1016/j.neuron.2015.08.020] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 07/14/2015] [Accepted: 08/10/2015] [Indexed: 10/23/2022]
Abstract
Progressive supranuclear palsy (PSP) is a movement disorder characterized by tau neuropathology where the underlying mechanism is unknown. An SNP (rs1768208 C/T) has been identified as a strong risk factor for PSP. Here, we identified a much higher T-allele occurrence and increased levels of the pro-apoptotic protein appoptosin in PSP patients. Elevations in appoptosin correlate with activated caspase-3 and caspase-cleaved tau levels. Appoptosin overexpression increased caspase-mediated tau cleavage, tau aggregation, and synaptic dysfunction, whereas appoptosin deficiency reduced tau cleavage and aggregation. Appoptosin transduction impaired multiple motor functions and exacerbated neuropathology in tau-transgenic mice in a manner dependent on caspase-3 and tau. Increased appoptosin and caspase-3-cleaved tau were also observed in brain samples of patients with Alzheimer's disease and frontotemporal dementia with tau inclusions. Our findings reveal a novel role for appoptosin in neurological disorders with tau neuropathology, linking caspase-3-mediated tau cleavage to synaptic dysfunction and behavioral/motor defects.
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MESH Headings
- Age Factors
- Aged
- Aged, 80 and over
- Alzheimer Disease/metabolism
- Animals
- Apoptosis/genetics
- Apoptosis Regulatory Proteins/genetics
- Apoptosis Regulatory Proteins/metabolism
- Brain/metabolism
- Brain/pathology
- Caspase 3/genetics
- Caspase 3/metabolism
- Cells, Cultured
- Disease Models, Animal
- Embryo, Mammalian
- Female
- Gene Expression Regulation/genetics
- Hand Strength/physiology
- Humans
- Male
- Mice
- Mice, Inbred C57BL
- Mice, Transgenic
- Middle Aged
- Myelin Proteins/genetics
- Myelin Proteins/metabolism
- Polymorphism, Single Nucleotide/genetics
- Rats
- Supranuclear Palsy, Progressive/genetics
- Supranuclear Palsy, Progressive/pathology
- Supranuclear Palsy, Progressive/physiopathology
- tau Proteins/genetics
- tau Proteins/metabolism
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Affiliation(s)
- Yingjun Zhao
- Fujian Provincial Key Laboratory of Neurodegenerative Disease and Aging Research, Institute of Neuroscience, College of Medicine, Xiamen University, Xiamen, Fujian 361102, China; Degenerative Diseases Program, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA 92037, USA
| | - I-Chu Tseng
- Degenerative Diseases Program, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA 92037, USA
| | - Charles J Heyser
- Department of Neuroscience, University of California San Diego, La Jolla, CA 92093, USA
| | - Edward Rockenstein
- Department of Neuroscience, University of California San Diego, La Jolla, CA 92093, USA
| | - Michael Mante
- Department of Neuroscience, University of California San Diego, La Jolla, CA 92093, USA
| | - Anthony Adame
- Department of Neuroscience, University of California San Diego, La Jolla, CA 92093, USA
| | - Qiuyang Zheng
- Fujian Provincial Key Laboratory of Neurodegenerative Disease and Aging Research, Institute of Neuroscience, College of Medicine, Xiamen University, Xiamen, Fujian 361102, China; Degenerative Diseases Program, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA 92037, USA
| | - Timothy Huang
- Degenerative Diseases Program, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA 92037, USA
| | - Xin Wang
- Fujian Provincial Key Laboratory of Neurodegenerative Disease and Aging Research, Institute of Neuroscience, College of Medicine, Xiamen University, Xiamen, Fujian 361102, China
| | - Pharhad E Arslan
- Tanz Centre for Research in Neurodegenerative Diseases, Krembil Discovery Tower, Toronto, ON M5T 2S8, Canada
| | - Paramita Chakrabarty
- Department of Neuroscience, Center for Translational Research in Neurodegenerative Diseases, University of Florida, Gainesville, FL 32610, USA
| | - Chengbiao Wu
- Department of Neuroscience, University of California San Diego, La Jolla, CA 92093, USA
| | - Guojun Bu
- Fujian Provincial Key Laboratory of Neurodegenerative Disease and Aging Research, Institute of Neuroscience, College of Medicine, Xiamen University, Xiamen, Fujian 361102, China
| | - William C Mobley
- Department of Neuroscience, University of California San Diego, La Jolla, CA 92093, USA
| | - Yun-Wu Zhang
- Fujian Provincial Key Laboratory of Neurodegenerative Disease and Aging Research, Institute of Neuroscience, College of Medicine, Xiamen University, Xiamen, Fujian 361102, China; Degenerative Diseases Program, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA 92037, USA
| | - Peter St George-Hyslop
- Tanz Centre for Research in Neurodegenerative Diseases, Krembil Discovery Tower, Toronto, ON M5T 2S8, Canada; Department of Medical Biophysics and Medicine (Neurology), University of Toronto, Toronto, ON M5S 3H2, Canada; Department of Clinical Neurosciences, Cambridge Institute for Medical Research, University of Cambridge, Cambridge, CB2 0XY, UK
| | - Eliezer Masliah
- Department of Neuroscience, University of California San Diego, La Jolla, CA 92093, USA; Department of Pathology, University of California San Diego, La Jolla, CA 92093, USA
| | - Paul Fraser
- Tanz Centre for Research in Neurodegenerative Diseases, Krembil Discovery Tower, Toronto, ON M5T 2S8, Canada; Department of Medical Biophysics and Medicine (Neurology), University of Toronto, Toronto, ON M5S 3H2, Canada
| | - Huaxi Xu
- Fujian Provincial Key Laboratory of Neurodegenerative Disease and Aging Research, Institute of Neuroscience, College of Medicine, Xiamen University, Xiamen, Fujian 361102, China; Degenerative Diseases Program, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA 92037, USA.
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Pradhan C, Wuehr M, Akrami F, Neuhaeusser M, Huth S, Brandt T, Jahn K, Schniepp R. Automated classification of neurological disorders of gait using spatio-temporal gait parameters. J Electromyogr Kinesiol 2015; 25:413-22. [PMID: 25725811 DOI: 10.1016/j.jelekin.2015.01.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 01/05/2015] [Accepted: 01/19/2015] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE Automated pattern recognition systems have been used for accurate identification of neurological conditions as well as the evaluation of the treatment outcomes. This study aims to determine the accuracy of diagnoses of (oto-)neurological gait disorders using different types of automated pattern recognition techniques. METHODS Clinically confirmed cases of phobic postural vertigo (N = 30), cerebellar ataxia (N = 30), progressive supranuclear palsy (N = 30), bilateral vestibulopathy (N = 30), as well as healthy subjects (N = 30) were recruited for the study. 8 measurements with 136 variables using a GAITRite(®) sensor carpet were obtained from each subject. Subjects were randomly divided into two groups (training cases and validation cases). Sensitivity and specificity of k-nearest neighbor (KNN), naive-bayes classifier (NB), artificial neural network (ANN), and support vector machine (SVM) in classifying the validation cases were calculated. RESULTS ANN and SVM had the highest overall sensitivity with 90.6% and 92.0% respectively, followed by NB (76.0%) and KNN (73.3%). SVM and ANN showed high false negative rates for bilateral vestibulopathy cases (20.0% and 26.0%); while KNN and NB had high false negative rates for progressive supranuclear palsy cases (76.7% and 40.0%). CONCLUSIONS Automated pattern recognition systems are able to identify pathological gait patterns and establish clinical diagnosis with good accuracy. SVM and ANN in particular differentiate gait patterns of several distinct oto-neurological disorders of gait with high sensitivity and specificity compared to KNN and NB. Both SVM and ANN appear to be a reliable diagnostic and management tool for disorders of gait.
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Affiliation(s)
- Cauchy Pradhan
- German Center for Vertigo and Balance Disorders, DSGZ, University of Munich, Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany.
| | - Max Wuehr
- German Center for Vertigo and Balance Disorders, DSGZ, University of Munich, Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany
| | - Farhoud Akrami
- German Center for Vertigo and Balance Disorders, DSGZ, University of Munich, Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany
| | - Maximilian Neuhaeusser
- German Center for Vertigo and Balance Disorders, DSGZ, University of Munich, Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany
| | - Sabrina Huth
- German Center for Vertigo and Balance Disorders, DSGZ, University of Munich, Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany
| | - Thomas Brandt
- German Center for Vertigo and Balance Disorders, DSGZ, University of Munich, Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany; Institute of Clinical Neurosciences, University of Munich, Munich, Germany
| | - Klaus Jahn
- German Center for Vertigo and Balance Disorders, DSGZ, University of Munich, Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany; Department of Neurology, Schön Klinik Bad Aibling, 83043 Bad Aibling, Germany
| | - Roman Schniepp
- German Center for Vertigo and Balance Disorders, DSGZ, University of Munich, Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany; Department of Neurology, University of Munich, Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany
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Danoudis M, Iansek R. Gait in Huntington's disease and the stride length-cadence relationship. BMC Neurol 2014; 14:161. [PMID: 25265896 PMCID: PMC4190343 DOI: 10.1186/s12883-014-0161-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 07/30/2014] [Indexed: 11/25/2022] Open
Abstract
Background The progressive deterioration of gait in Huntington’s disease (HD) leads to functional decline and loss of function. To understand the underlying mechanisms responsible for the gait changes in HD, we examined the automatic control of gait by measuring the relationship between stride length and cadence. The relationship is strongly linked in healthy adults during automatic gait but disrupted in pathological gait disorders, such as Parkinson’s disease (PD). Methods The stride length cadence relationship was compared between seventeen participants with HD, twenty with PD and twenty one healthy older adults (HOA). Participants had their gait recorded at self-selected preferred, very slow, slow, fast and very fast speeds. Linear regression analysis was used to determine the slope and intercept of the relationship which were compared between groups. The adjustment of stride length and cadence when changing gait speeds was measured and compared within and between groups. Results Linearity was strong in all but two participants with HD and one with PD. Slope did not differ between groups (p > 0.05) but intercept was lower in the HD and PD groups compared to HOA (p < 0.05). Stride length was shorter in the HD and PD groups compared to controls at preferred and most adjusted speed conditions (p < 0.05) but cadence did not differ between groups (p > 0.05) regardless of speed. The HD group adjusted stride length and cadence similar to HOA when changing speed. The range of cadence across speed conditions did not differ between groups. Conclusion Scaling of stride length but not the regulation of cadence was found to be disrupted in participants with HD.
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Egerton T, Thingstad P, Helbostad JL. Comparison of programs for determining temporal-spatial gait variables from instrumented walkway data: PKmas versus GAITRite. BMC Res Notes 2014; 7:542. [PMID: 25134621 PMCID: PMC4150969 DOI: 10.1186/1756-0500-7-542] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 08/13/2014] [Indexed: 11/12/2022] Open
Abstract
Background Measurement of temporal-spatial gait variables is common in aging research with several methods available. This study investigated the differences in temporal-spatial gait outcomes derived from two different programs for processing instrumented walkway data. Method Data were collected with GAITRite® hardware from 86 healthy older people and 44 older people four months following surgical repair of hip fracture. Temporal-spatial variables were derived using both GAITRite® and PKmas® processing programs from the same raw footfall data. Results The mean differences between the two programs for most variables were negligible, including for Speed (mean difference 0.3 ± 0.6 cm/sec, or 0.3% of the mean GAITRite® Speed). The mean absolute percentage difference for all 18 gait variables examined ranged from 0.04% for Stride Duration to 66% for Foot Angle. The ICCs were almost perfect (≥0.99) for all variables apart from Base Width, Foot Angle, Stride Length Variability, Step Length Variability, Step Duration Variability and Step Width Variability, which were all never-the-less above 0.84. There were systematic differences for Base Width (PKmas® values 1.6 cm lower than GAITRite®) and Foot Angle (PKMAS® values 0.7° higher than GAITRite®). The differences can be explained by the differences in definitions and calculations between the programs. Conclusions The study demonstrated that for most variables the outcomes from both programs can be used interchangeably for evaluation of gait among older people collected with GAITRite® hardware. However, validity and reliability for Base Width and Foot Angle derived by PKMAS® would benefit from further investigation. Electronic supplementary material The online version of this article (doi:10.1186/1756-0500-7-542) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thorlene Egerton
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.
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Baston C, Mancini M, Schoneburg B, Horak F, Rocchi L. Postural strategies assessed with inertial sensors in healthy and parkinsonian subjects. Gait Posture 2014; 40:70-5. [PMID: 24656713 PMCID: PMC4383136 DOI: 10.1016/j.gaitpost.2014.02.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 02/11/2014] [Accepted: 02/20/2014] [Indexed: 02/02/2023]
Abstract
UNLABELLED The present study introduces a novel instrumented method to characterize postural movement strategies to maintain balance during stance (ankle and hip strategy), by means of inertial sensors, positioned on the legs and on the trunk. We evaluated postural strategies in subjects with 2 types of Parkinsonism: idiopathic Parkinson's disease (PD) and Progressive Supranuclear Palsy (PSP), and in age-matched control subjects standing under perturbed conditions implemented by the Sensory Organization Test (SOT). Coordination between the upper and lower segments of the body during postural sway was measured using a covariance index over time, by a sliding-window algorithm. Afterwards, a postural strategy index was computed. We also measured the amount of postural sway, as adjunctive information to characterize balance, by the root mean square of the horizontal trunk acceleration signal (RMS). RESULTS showed that control subjects were able to change their postural strategy, whilst PSP and PD subjects persisted in use of an ankle strategy in all conditions. PD subjects had RMS values similar to control subjects even without changing postural strategy appropriately, whereas PSP subjects showed much larger RMS values than controls, resulting in several falls during the most challenging SOT conditions (5 and 6). Results are in accordance with the corresponding clinical literature describing postural behavior in the same kind of subjects. The proposed strategy index, based on the use of inertial sensors on the upper and lower body segments, is a promising and unobtrusive tool to characterize postural strategies performed to attain balance.
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Affiliation(s)
- Chiara Baston
- Department of Electrical, Electronic and Information Engineering “Guglielmo Marconi”, University of Bologna, Bologna, Italy
| | - Martina Mancini
- Department of Neurology, School of Medicine, Oregon Health & Science University, 3181 Sam Jackson Park Road, Portland, OR 97239-3098, USA
| | - Bernadette Schoneburg
- Department of Neurology, School of Medicine, Oregon Health & Science University, 3181 Sam Jackson Park Road, Portland, OR 97239-3098, USA
| | - Fay Horak
- Department of Neurology, School of Medicine, Oregon Health & Science University, 3181 Sam Jackson Park Road, Portland, OR 97239-3098, USA
| | - Laura Rocchi
- Department of Electrical, Electronic and Information Engineering “Guglielmo Marconi”, University of Bologna, Bologna, Italy
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