1
|
Wong PL, Hung CW, Yang YR, Yeh NC, Cheng SJ, Liao YY, Wang RY. Effects of motor and cognitive complex training on obstacle walking and brain activity in people with Parkinson's disease: a randomized controlled trial. Eur J Phys Rehabil Med 2024; 60:611-620. [PMID: 38743389 DOI: 10.23736/s1973-9087.24.08261-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
BACKGROUND The difficulties in obstacle walking are significant in people with Parkinson's disease (PD) leading to an increased fall risk. Effective interventions to improve obstacle walking with possible training-related neuroplasticity changes are needed. We developed two different exercise programs, complex walking training and motor-cognitive training, both challenging motor and cognitive function for people with PD to improve obstacle walking. AIM To investigate the effects of these two novel training programs on obstacle walking and brain activities in PD. DESIGN A single-center randomized, single-blind controlled study. SETTING University laboratory; outpatient. POPULATION Individuals with idiopathic PD. METHODS Thirty-two participants were randomly assigned to the complex walking training group (N.=11), motor-cognitive training group (N.=11) or control group (N.=10). Participants in training groups received exercises for 40 minutes/session, with a total of 12-session over 6 weeks. Control group did not receive additional training. Primary outcomes included obstacle walking, and brain activities (prefrontal cortex (PFC), premotor cortex (PMC), and supplementary motor area (SMA)) during obstacle walking by using functional near-infrared spectroscopy. Secondary outcomes included obstacle crossing, timed up and go test (TUG), cognitive function in different domains, and fall efficacy scale (FES-I). RESULTS The motor-cognitive training group demonstrated greater improvements in obstacle walking speed and stride length, SMA activity, obstacle crossing velocity and stride length, digit span test, and TUG than the control group. The complex walking training did not show significant improvement in obstacle walking or change in brain activation compared with control group. However, the complex walking training resulted in greater improvements in Rey-Osterrieth Complex Figure test, TUG and FES-I compared with the control group. CONCLUSIONS Our 12-session of the cognitive-motor training improved obstacle walking performance with increased SMA activities in people with PD. However, the complex walking training did not lead such beneficial effects as the cognitive-motor training. CLINICAL REHABILITATION IMPACT The cognitive-motor training is suggested as an effective rehabilitation program to improve obstacle walking ability in individuals with PD.
Collapse
Affiliation(s)
- Pei-Ling Wong
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan (ROC)
| | - Chen-Wei Hung
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan (ROC)
| | - Yea-Ru Yang
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan (ROC)
| | - Nai-Chen Yeh
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan (ROC)
| | - Shih-Jung Cheng
- Department of Neurology, Mackay Memorial Hospital, Taipei, Taiwan (ROC)
| | - Ying-Yi Liao
- Department of Gerontological Health Care, National Taipei University of Nursing and Health Science, Taipei, Taiwan (ROC)
| | - Ray-Yau Wang
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan (ROC) -
| |
Collapse
|
2
|
Law NY, Li JX. Effects of a 12-week online Tai Chi intervention on gait and postural stability in individuals with Parkinson's disease. SPORTS MEDICINE AND HEALTH SCIENCE 2023; 5:239-244. [PMID: 37753420 PMCID: PMC10518795 DOI: 10.1016/j.smhs.2023.07.004] [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: 09/18/2022] [Revised: 06/08/2023] [Accepted: 07/08/2023] [Indexed: 09/28/2023] Open
Abstract
Parkinson's disease (PD) affects gait and postural stability. Tai Chi (TC) is recommended for PD for management of the condition, however biomechanical understanding to its effects on gait and postural stability is limited. This study aimed to examine the effects of an online 12-week biomechanical-based TC intervention on gait and posture in people with PD. Fifteen individuals in early-stage PD were recruited (Hoehn & Yahr stages 1-2). The TC intervention program was 60 min session, three times weekly for 12 weeks. The pre- and post-intervention test in obstacle crossing, timed-up-and-go (TUG) test, and single leg standing (SLS) with eyes open (EO) and closed (EC) were conducted. Gait speed, crossing stride length, clearance height of the heel and toe, anterior-posterior (AP) and medial-lateral (ML) displacement and velocity of the center of mass (COM) and separation of the COM-center of pressure (COP) were analyzed. The participants significantly improved their pre-vs. post-TC intervention performance on TUG test (p = 0.002). During obstacle crossing, the participants significantly increased crossing stride length of the trailing foot, increased AP COM displacement and decreased ML COM-COP separation (p < 0.05); the maximal dorsiflexion angle of the leading limb significantly increased and maximal plantarflexion angle of the trailing limb significantly decreased (p < 0.05). A 12-week biomechanical-based online TC training was effective towards improvement of gait and postural stability among people in the early-stage of PD. The TC program and online training could be applied for management of PD.
Collapse
Affiliation(s)
- Nok-Yeung Law
- School of Human Kinetics, University of Ottawa, Canada
| | - Jing Xian Li
- School of Human Kinetics, University of Ottawa, Canada
| |
Collapse
|
3
|
Gao B, Li L, Shen P, Zhou Z, Xu P, Sun W, Zhang C, Song Q. Effects of proprioceptive neuromuscular facilitation stretching in relieving pain and balancing knee loading during stepping over obstacles among older adults with knee osteoarthritis: A randomized controlled trial. PLoS One 2023; 18:e0280941. [PMID: 36780435 PMCID: PMC9924997 DOI: 10.1371/journal.pone.0280941] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 11/04/2022] [Indexed: 02/15/2023] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the effects of an 8-week proprioceptive neuromuscular facilitation (PNF) stretching in relieving pain and balancing knee loading during stepping over obstacles among older people with knee osteoarthritis, and further explore the improvements in gait patterns. DESIGN Thirty-two older adults (66~72 years) with KOA were recruited and randomly assigned into PNF or control groups. They received PNF stretching or health lecture series for 8 weeks. Final data analyses were conducted among 13 participants in the PNF and 14 in the control groups. At weeks 0 and 9, they were asked to step over an obstacle of 20% of their leg length. The pain scores and knee abduction moment (KAM) (primary outcomes) were analyzed by multivariate ANOVA, and the gait variables (secondary outcomes) were analyzed by two-way (group by pre-/post) ANOVAs with repeated measures. RESULTS Significant interactions were detected in the pain score, first and second peaks of KAM, and crossing velocity during stepping over obstacles, and significant between-group differences of these outcomes were detected at week 9. CONCLUSION An 8-week PNF stretching could relieve pain and balance loading between knee compartments, as well as increase crossing velocity during stepping over obstacles. TRIAL REGISTRATION Chinese Clinical Trial Registry: ChiCTR2100042278.
Collapse
Affiliation(s)
- Bo Gao
- The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Li Li
- Department of Health Sciences and Kinesiology, Georgia Southern University, Statesboro, Georgia, United States of America
| | - Peixin Shen
- School of Sport Science, Beijing Sport University, Beijing, China
- College of Sports and Health, Shandong Sport University, Jinan, China
| | - Zhipeng Zhou
- College of Sports and Health, Shandong Sport University, Jinan, China
| | - Peiming Xu
- Enterprise Technology Centre, Taishan Sports Industry Group, Leling, China
| | - Wei Sun
- College of Sports and Health, Shandong Sport University, Jinan, China
| | - Cui Zhang
- Laboratory of Biomechanics, Shandong Institute of Sport Science, Jinan, China
| | - Qipeng Song
- College of Sports and Health, Shandong Sport University, Jinan, China
- * E-mail:
| |
Collapse
|
4
|
Tuijtelaars J, Jeukens-Visser M, Nollet F, Brehm MA. Factors associated with walking adaptability and its association with falling in polio survivors. Arch Phys Med Rehabil 2022; 103:1983-1991. [PMID: 35644215 DOI: 10.1016/j.apmr.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 05/10/2022] [Accepted: 05/10/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Jana Tuijtelaars
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Martine Jeukens-Visser
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Frans Nollet
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Merel-Anne Brehm
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands.
| |
Collapse
|
5
|
Luo Y, Yang F, Yerebakan MO, Zhang J, Hu B. Load Carriage Modes and Limb Crossing Patterns Altered Gait during Obstacle Negotiation. J Mot Behav 2022; 54:525-536. [PMID: 35021959 DOI: 10.1080/00222895.2021.2017837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Personal and environmental factors both increase the likelihood of falling injuries while negotiating obstacles. Eighteen male participants (seven older, eleven young) were recruited to walk over an obstacle with and without loads on their hands to study the effects of age, load carriage modes, and limb crossing patterns on gait during obstacle negotiation. Participants initiated tasks with either their dominant or non-dominant leg. Step length (SL), toe clearance (TC), step velocity (V), and step width (SW) were extracted from four critical steps. Results showed that during obstacle negotiation (1) older adults had more TC than younger adults, (2) hand loads affected SL and TC, (3) gait parameters are dissimilar between the dominant limb and non-dominant limb.
Collapse
Affiliation(s)
- Yue Luo
- Human System Engineering Laboratory, Department of Industrial and Systems Engineering, University of Florida, Gainesville, Florida
| | - Fang Yang
- School of Mechanical Engineering, Tianjin University of Science and Technology, Tianjin, China
| | - Mustafa Ozkan Yerebakan
- Human System Engineering Laboratory, Department of Industrial and Systems Engineering, University of Florida, Gainesville, Florida
| | - Junxia Zhang
- School of Mechanical Engineering, Tianjin University of Science and Technology, Tianjin, China
| | - Boyi Hu
- Human System Engineering Laboratory, Department of Industrial and Systems Engineering, University of Florida, Gainesville, Florida
| |
Collapse
|
6
|
Kaewkaen K, Chueathaeo T, Angart S, Chomkan S, Uttama S, Chaiut W, Namkorn P, Sutalangka C, Kaewkaen P. The interactive effect of cognitive and physical dual task interventions on obstacle negotiation while walking in healthy young, and older, adults. Neurol India 2021; 69:883-888. [PMID: 34507406 DOI: 10.4103/0028-3886.325349] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Context Dual task performance affects obstacle crossing ability in older adults. Previous studies suggest that cognitive dual tasking can lead to changes in obstacle crossing performance in older adults, but there is a lack of evidence to support changes in obstacle crossing performance due to the influence of motor dual tasking. Aims To investigate the interaction of cognitive and motor tasks, on obstacle crossing performance, in healthy young and older adults. Settings and Design This is a cross sectional comparative study, conducted at Mae Fah Luang University, Thailand. Methods and Material Sixty-four participants performed an obstacle crossing task under three conditions during a 4-meter walk test. These included walking at their normal speed with an obstacle in the middle of the walkway, followed by 2 further order-randomized walking conditions comprising a cognitive and a motor dual tasking walking condition. The spatio-temporal gait variables and obstacle crossing kinematic variables were measured using a Kinect three-camera system. Statistical Analysis Used The means for each variable, and for each condition, were analyzed using a mixed model analysis of variance (ANOVA) with walking conditions as covariant factors. Results A significant main interaction effect was found in gait speed (P < 0.001), step length (P = 0.046) and cadence (P = 0.011), but there was only a significant between-group difference in step length during obstacle crossing, while performing a cognitive dual task (P = 0.008) and a motor dual task (P < 0.001). Conclusions Older adults adopted a conservative strategy, and walked with a shorter step length, when stepping over an obstacle while performing a dual task.
Collapse
Affiliation(s)
- Kitchana Kaewkaen
- Department of Physical Therapy, School of Health Science, Mae Fah Luang University, Chang Wat Chiang Rai; Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH) Khon Kaen University, Nai-Muang, Muang District, Khon Kaen, Thailand
| | - Tulaporn Chueathaeo
- Department of Physical Therapy, School of Health Science, Mae Fah Luang University, Chang Wat Chiang Rai, Thailand
| | - Siwanart Angart
- Department of Physical Therapy, School of Health Science, Mae Fah Luang University, Chang Wat Chiang Rai, Thailand
| | - Sirikul Chomkan
- Department of Physical Therapy, School of Health Science, Mae Fah Luang University, Chang Wat Chiang Rai, Thailand
| | - Surapong Uttama
- School of Information Technology, Mae Fah Luang University, Chang Wat Chiang Rai, Thailand
| | - Wilawan Chaiut
- Department of Physical Therapy, School of Health Science, Mae Fah Luang University, Chang Wat Chiang Rai, Thailand
| | - Ploypailin Namkorn
- Department of Physical Therapy, School of Health Science, Mae Fah Luang University, Chang Wat Chiang Rai; Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH) Khon Kaen University, Nai-Muang, Muang District, Khon Kaen, Thailand
| | - Chatchada Sutalangka
- Department of Physical Therapy, School of Health Science, Mae Fah Luang University, Chang Wat Chiang Rai, Thailand
| | - Pratchaya Kaewkaen
- College of Research Methodology and Cognitive Science, Burapha University, Tambon Saen Suk, Amphoe Mueang Chon Buri, Chang Wat Chon Buri, Thailand
| |
Collapse
|
7
|
Kim J, Kim I, Kim YE, Koh SB. The Four Square Step Test for Assessing Cognitively Demanding Dynamic Balance in Parkinson's Disease Patients. J Mov Disord 2021; 14:208-213. [PMID: 34030434 PMCID: PMC8490191 DOI: 10.14802/jmd.20146] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 03/17/2021] [Indexed: 11/24/2022] Open
Abstract
Objective
The Four Square Step Test (FSST) is a tool that assesses dynamic balance during obstacle step-over. To date, few studies have used the FSST to measure balance in patients with Parkinson’s disease (PD). This study aimed to verify that patients with PD, even at the de novo early stage, take more time to perform the FSST and identify which factors, cognitive status or cardinal motor symptoms, are related most to FSST scores. Methods
Thirty-five newly diagnosed drug-naïve patients with PD and 17 controls completed the FSST. The Unified Parkinson’s Disease Rating Scale (UPDRS), Hoehn and Yahr (H&Y) stage, spatiotemporal gait parameters, and neuropsychological test battery were also assessed in the PD group. Results
Mean FSST performance time was 8.20 ± 1.61 seconds in patients with PD, which was significantly more than the control group (7.13 ± 1.10 seconds, p = 0.018). UPDRS part III total score and H&Y stage were not significantly associated with FSST, but among the UPDRS subscores, only the postural instability/gait disturbance subscore showed a significant association. Regarding the association between FSST and cognition, the Trail Making Test-B and the Color Word Stroop Test showed strongly inverse correlations with FSST (rho = -0.598 and -0.590, respectively). With respect to gait parameters, double support time was significantly associated with FSST score (rho = 0.342, p = 0.044); however, other parameters, including velocity and step length, were not associated with the FSST. Conclusion
The FSST can be used in the clinic to assess dynamic balance with cognitive demands even in the early stages of PD.
Collapse
Affiliation(s)
- Jinhee Kim
- Department of Neurology and Parkinson's Disease Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ilsoo Kim
- Department of Neurology and Parkinson's Disease Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ye Eun Kim
- Department of Neurology and Parkinson's Disease Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seong-Beom Koh
- Department of Neurology and Parkinson's Disease Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| |
Collapse
|
8
|
Stroke survivors exhibit stronger lower extremity synergies in more challenging walking conditions. Exp Brain Res 2019; 237:1919-1930. [PMID: 31106386 DOI: 10.1007/s00221-019-05560-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 05/11/2019] [Indexed: 10/26/2022]
Abstract
The aim of this study was to examine how kinematic synergies are utilised as compensatory movements to stabilise foot positions under different walking task constraints in people with stroke. Ten (Males = 6, Females = 4) hemiplegic chronic stroke survivors volunteered to participate in this study, recruited from a rehabilitation centre. They completed a consent form and participated in treadmill walking tasks; flat, uphill, and crossing over a moving obstacle. The uncontrolled manifold method was used to quantify kinematic synergies in the paretic and non-paretic legs during their swing phase. The results of this study showed the strength of synergies was significantly greater in the obstacle task than in the uphill walking tasks at mid and terminal swing phases. In conclusion, the results suggest that walking in the challenging situations caused people with stroke to control step stability with greater compensation between lower extremity joints. Participants adapted to the increased challenge by increasing the amount of 'good variability', which could be a strategy to reduce the risks of falling.
Collapse
|
9
|
Alcock L, Galna B, Hausdorff JM, Lord S, Rochester L. Gait & Posture Special Issue: Gait adaptations in response to obstacle type in fallers with Parkinson's disease. Gait Posture 2018; 61:368-374. [PMID: 29448219 DOI: 10.1016/j.gaitpost.2018.01.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 01/22/2018] [Accepted: 01/25/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Gait impairment places older adults and people with Parkinson's disease (PD) at an increased risk of falls when walking over obstacles. Increasing the height of obstacles results in greater challenge to balance however little is known about the demands encountered when negotiating obstacles of greater depth which may be greater for PD who often walk with a short, shuffling gait. RESEARCH QUESTION To describe gait adaptation in older adults and people with PD when walking over long and tall obstacles. METHODS 20 people with PD and 13 older adults with a history of falls walked across an instrumented walkway under four conditions: level walking, and over a small, long and tall obstacle. Differences due to group, step and obstacle type were evaluated using General Linear Models. RESULTS An increased step duration, longer single limb support and a wider step (p < .033) were observed when crossing the tall obstacle for both older adults and PD. The PD group completed the crossing steps more slowly than controls, with a shorter step and longer single limb support (p < .043). Obstacle type did not significantly influence step length. SIGNIFICANCE The greatest temporal-spatial adaptations were elicited when participants negotiated the tall obstacle. Electing a wider step when crossing the tall obstacle was a strategy common to both faller groups (older adults and PD). The tall obstacle presented added challenge for PD who spent longer in single limb support during the crossing steps compared to controls. The long obstacle did not cause a disproportionate change in step length in people with PD, and we suggest that the obstacle may have acted as a visual cue in this group.
Collapse
Affiliation(s)
- Lisa Alcock
- Institute of Neuroscience/Institute for Ageing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Brook Galna
- Institute of Neuroscience/Institute for Ageing, Newcastle University, Newcastle upon Tyne, United Kingdom; School of Biomedical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA; Sagol School of Neuroscience and Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sue Lord
- Institute of Neuroscience/Institute for Ageing, Newcastle University, Newcastle upon Tyne, United Kingdom; School of Clinical Sciences, Auckland University of Technology, New Zealand
| | - Lynn Rochester
- Institute of Neuroscience/Institute for Ageing, Newcastle University, Newcastle upon Tyne, United Kingdom; The Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.
| |
Collapse
|
10
|
Shafizadeh M, Wheat J, Davids K, Ansari NN, Ali A, Garmabi S. Constraints on perception of information from obstacles during foot clearance in people with chronic stroke. Exp Brain Res 2017; 235:1665-1676. [PMID: 28271220 DOI: 10.1007/s00221-017-4920-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 02/16/2017] [Indexed: 02/08/2023]
Abstract
The aim of this study was to examine effects of different types of task constraints on coupling of perception and action in people with chronic stroke when crossing obstacles during a walking task. Ten participants with hemiplegic chronic stroke volunteered to walk over a static obstacle under two distinct task constraints: simple and dual tasks. Under simple task constraints, without specific instructions, participants walked at their preferred speed and crossed over an obstacle. Under dual task constraints, the same individuals were required to subtract numbers whilst walking. Under both distinct task constraints, we examined emergent values of foot distance when clearing a static obstacle in both affected and unaffected legs, measured by a 3D motion tracking system. Principal component analysis was used to quantify task performance, and discriminant analysis was used to compare gait performance between task constraints. Results suggested that patients, regardless of affected body side, demonstrated differences in perception of distance information from the obstacle, which constrained gait differences in initial swing, mid-swing, and crossing phases. Furthermore, dual task constraints, rather than hemiplegic body side, were a significant discriminator in patients' perceptions of distance and height information to the obstacle. These findings suggested how performance of additional cognitive tasks might constrain perception of information from an obstacle in people with chronic stroke during different phases of obstacle crossing, and thus may impair their adaptive ability to successfully manoeuvre around objects.
Collapse
Affiliation(s)
- Mohsen Shafizadeh
- Faculty of Health and Wellbeing, Academy of Sport and Physical Activity, Sheffield Hallam University, Sheffield, S10 2BP, UK.
| | - Jonathan Wheat
- Faculty of Health and Wellbeing, Centre for Sport Engineering Research, Sheffield Hallam University, Sheffield, S10 2BP, UK
| | - Keith Davids
- Faculty of Health and Wellbeing, Centre for Sport Engineering Research, Sheffield Hallam University, Sheffield, S10 2BP, UK
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Ali
- Department of Geriatrics and Stroke Medicine, Sheffield Teaching Hospitals, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK
| | - Samira Garmabi
- University of Social Welfare and Rehabilitation Sciences, Kodakyar Ave, Daneshjo Blvd, Evin, Tehran, 1985713834, Iran
| |
Collapse
|
11
|
Indoor and outdoor falls in persons with Parkinson's disease after 1 year follow-up study: differences and consequences. Neurol Sci 2016; 37:597-602. [PMID: 26879312 DOI: 10.1007/s10072-016-2504-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/03/2016] [Indexed: 10/22/2022]
Abstract
Falls among persons with Parkinson's disease (PD) often result in activity limitations, participation restrictions, social isolation or premature mortality. The purpose of this 1-year follow-up study was to compare potential differences in features of PD attributing to falls in relation to fall location (outdoor vs. indoor). We recruited 120 consecutive persons with PD who denied having fallen in the past 6 months. Disease stage and severity was assessed using the Hoehn and Yahr scale and the newer version of the Unified Parkinson's Disease Rating Scale. Occurrence of falling and characteristics of falls was followed for 1 year. Results were assessed statistically. Outdoor falls were more commonly preceded by the extrinsic factors (tripping and slipping). Slipping was more common outdoors (p = 0.001). Indoor falls were mostly preceded by the intrinsic factors (postural instability, lower extremity weakness, vertigo). Vertigo was more common indoors (p = 0.006). Occurrence of injuries was more common after outdoor falls (p = 0.001). Indoor falls resulted in contusions only, while outdoor falls resulted in lacerations and fractures as well. In the regression model adjusted for age, disease duration, on/off phase during fall, Hoehn and Yahr stage of disease and levodopa dosage, slipping was associated with outdoor falling (odds ratio = 17.25, 95 % confidence interval 3.33-89.20, p = 0.001). These findings could be used to tailor fall prevention program with emphasis on balance recovery and negotiation of objects in environment.
Collapse
|
12
|
Virtual Reality-Based Wii Fit Training in Improving Muscle Strength, Sensory Integration Ability, and Walking Abilities in Patients with Parkinson's Disease: A Randomized Control Trial. INT J GERONTOL 2015. [DOI: 10.1016/j.ijge.2014.06.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
13
|
Bovonsunthonchai S, Khobkhun F, Vachalathiti R. Ground Reaction Forces of the Lead and Trail Limbs when Stepping Over an Obstacle. Med Sci Monit 2015; 21:2041-9. [PMID: 26169293 PMCID: PMC4514366 DOI: 10.12659/msm.893965] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Precise force generation and absorption during stepping over different obstacles need to be quantified for task accomplishment. This study aimed to quantify how the lead limb (LL) and trail limb (TL) generate and absorb forces while stepping over obstacle of various heights. MATERIAL AND METHODS Thirteen healthy young women participated in the study. Force data were collected from 2 force plates when participants stepped over obstacles. Two limbs (right LL and left TL) and 4 conditions of stepping (no obstacle, stepping over 5 cm, 20 cm, and 30 cm obstacle heights) were tested for main effect and interaction effect by 2-way ANOVA. Paired t-test and 1-way repeated-measure ANOVA were used to compare differences of variables between limbs and among stepping conditions, respectively. The main effects on the limb were found in first peak vertical force, minimum vertical force, propulsive peak force, and propulsive impulse. RESULTS Significant main effects of condition were found in time to minimum force, time to the second peak force, time to propulsive peak force, first peak vertical force, braking peak force, propulsive peak force, vertical impulse, braking impulse, and propulsive impulse. Interaction effects of limb and condition were found in first peak vertical force, propulsive peak force, braking impulse, and propulsive impulse. CONCLUSIONS Adaptations of force generation in the LL and TL were found to involve adaptability to altered external environment during stepping in healthy young adults.
Collapse
Affiliation(s)
| | - Fuengfa Khobkhun
- Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
| | | |
Collapse
|
14
|
Liao YY, Yang YR, Cheng SJ, Wu YR, Fuh JL, Wang RY. Virtual Reality-Based Training to Improve Obstacle-Crossing Performance and Dynamic Balance in Patients With Parkinson's Disease. Neurorehabil Neural Repair 2014; 29:658-67. [PMID: 25539782 DOI: 10.1177/1545968314562111] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Obstacle crossing is a balance-challenging task and can cause falls in people with Parkinson's disease (PD). However, programs for people with PD that effectively target obstacle crossing and dynamic balance have not been established. OBJECTIVE To examine the effects of virtual reality-based exercise on obstacle crossing performance and dynamic balance in participants with PD. METHODS Thirty-six participants with a diagnosis of PD (Hoehn and Yahr score ranging 1 to 3) were randomly assigned to one of three groups. In the exercise groups, participants received virtual reality-based Wii Fit exercise (VRWii group) or traditional exercise (TE group) for 45 minutes, followed by 15 minutes of treadmill training in each session for a total of 12 sessions over 6 weeks. Participants in the control group received no structured exercise program. Primary outcomes included obstacle crossing performance (crossing velocity, stride length, and vertical toe obstacle clearance) and dynamic balance (maximal excursion, movement velocity, and directional control measured by the limits-of-stability test). Secondary outcomes included sensory organization test (SOT), Parkinson's Disease Questionnaire (PDQ39), fall efficacy scale (FES-I), and timed up and go test (TUG). All outcomes were assessed at baseline, after training, and at 1-month follow-up. RESULTS The VRWii group showed greater improvement in obstacle crossing velocity, crossing stride length, dynamic balance, SOT, TUG, FES-I, and PDQ39 than the control group. VRWii training also resulted in greater improvement in movement velocity of limits-of-stability test than TE training. CONCLUSIONS VRWii training significantly improved obstacle crossing performance and dynamic balance, supporting implementation of VRWii training in participants with PD.
Collapse
Affiliation(s)
- Ying-Yi Liao
- Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan National Yang-Ming University, Taipei, Taiwan
| | - Yea-Ru Yang
- National Yang-Ming University, Taipei, Taiwan
| | - Shih-Jung Cheng
- Department of Neurology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Yih-Ru Wu
- Department of Neurology, Chang-Gung Memorial Hospital, Linkou, Taiwan Chang-Gung University College of Medicine, Linkou, Taiwan
| | - Jong-Ling Fuh
- National Yang-Ming University, Taipei, Taiwan Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | | |
Collapse
|
15
|
Gazibara T, Pekmezovic T, Tepavcevic DK, Tomic A, Stankovic I, Kostic VS, Svetel M. Circumstances of falls and fall-related injuries among patients with Parkinson's disease in an outpatient setting. Geriatr Nurs 2014; 35:364-9. [DOI: 10.1016/j.gerinurse.2014.05.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 05/07/2014] [Accepted: 05/12/2014] [Indexed: 10/25/2022]
|