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Beylergil SB, Noecker AM, Kilbane C, McIntyre CC, Shaikh AG. Does Vestibular Motion Perception Correlate with Axonal Pathways Stimulated by Subthalamic Deep Brain Stimulation in Parkinson's Disease? CEREBELLUM (LONDON, ENGLAND) 2024; 23:554-569. [PMID: 37308757 DOI: 10.1007/s12311-023-01576-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 06/14/2023]
Abstract
Perception of our linear motion - heading - is critical for postural control, gait, and locomotion, and it is impaired in Parkinson's disease (PD). Deep brain stimulation (DBS) has variable effects on vestibular heading perception, depending on the location of the electrodes within the subthalamic nucleus (STN). Here, we aimed to find the anatomical correlates of heading perception in PD. Fourteen PD participants with bilateral STN DBS performed a two-alternative forced-choice discrimination task where a motion platform delivered translational forward movements with a heading angle varying between 0 and 30° to the left or to the right with respect to the straight-ahead direction. Using psychometric curves, we derived the heading discrimination threshold angle of each patient from the response data. We created patient-specific DBS models and calculated the percentages of stimulated axonal pathways that are anatomically adjacent to the STN and known to play a major role in vestibular information processing. We performed correlation analyses to investigate the extent of these white matter tracts' involvement in heading perception. Significant positive correlations were identified between improved heading discrimination for rightward heading and the percentage of activated streamlines of the contralateral hyperdirect, pallido-subthalamic, and subthalamo-pallidal pathways. The hyperdirect pathways are thought to provide top-down control over STN connections to the cerebellum. In addition, STN may also antidromically activate collaterals of hyperdirect pathway that projects to the precerebellar pontine nuclei. In select cases, there was strong activation of the cerebello-thalamic projections, but it was not consistently present in all participants. Large volumetric overlap between the volume of tissue activation and the STN in the left hemisphere positively impacted rightward heading perception. Altogether, the results suggest heavy involvement of basal ganglia cerebellar network in STN-induced modulation of vestibular heading perception in PD.
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Affiliation(s)
- Sinem Balta Beylergil
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
- National VA Parkinson Consortium Center, Neurology Service, Daroff-Dell'Osso Ocular Motility and Vestibular Laboratory, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Angela M Noecker
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Camilla Kilbane
- Department of Neurology, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44110, USA
- Movement Disorders Center, Neurological Institute, University Hospitals, Cleveland, OH, USA
| | - Cameron C McIntyre
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Aasef G Shaikh
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.
- National VA Parkinson Consortium Center, Neurology Service, Daroff-Dell'Osso Ocular Motility and Vestibular Laboratory, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA.
- Department of Neurology, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44110, USA.
- Movement Disorders Center, Neurological Institute, University Hospitals, Cleveland, OH, USA.
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Mirando M, Penati R, Godi M, Giardini M, Nardone A. The Effect of Upright Stance and Vision on a Cognitive Task in Elderly Subjects and Patients with Parkinson's Disease. Brain Sci 2024; 14:305. [PMID: 38671957 PMCID: PMC11047827 DOI: 10.3390/brainsci14040305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/07/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
Standing compared to sitting enhances cognitive performance in healthy subjects. The effect of stance on cognitive performance has been addressed here in patients with Parkinson's disease (PwPD). We hypothesized that a simple cognitive task would be less enhanced in PwPD by standing with respect to sitting, because of a larger cognitive effort for maintenance of standing posture than in healthy subjects. We recruited 40 subjects (20 PwPD and 20 age-matched healthy subjects, HE). Each participant performed an arithmetic task (backward counting aloud by 7) in two postural states, sitting and standing, with eyes open (EO) and with eyes closed (EC). All trials lasted 60 s and were randomized across subjects and conditions. The number of correct subtractions per trial was an index of counting efficiency and the ratio of correct subtractions to total subtractions was an index of accuracy. All conditions collapsed, the efficiency of the cognitive task was significantly lower in PwPD than HE, whilst accuracy was affected to a lower extent. Efficiency significantly improved from sitting to standing in HE under both visual conditions whilst only with EO in PwPD. Accuracy was not affected by posture or vision in either group. We suggest that standing, compared to sitting, increases arousal, thus improving the cognitive performance in HE. Conversely, in PwPD this improvement was present only with vision, possibly due to their greater balance impairment with EC consuming an excess of attentional resources. These findings have implications for balance control and the risk of falling in PwPD in the absence of visual cues.
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Affiliation(s)
- Marta Mirando
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy; (M.M.); (R.P.)
| | - Rachele Penati
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy; (M.M.); (R.P.)
| | - Marco Godi
- Physical Medicine and Rehabilitation Unit of Veruno Institute, Istituti Clinici Scientifici Maugeri IRCCS, 28010 Veruno, Italy; (M.G.); (M.G.)
| | - Marica Giardini
- Physical Medicine and Rehabilitation Unit of Veruno Institute, Istituti Clinici Scientifici Maugeri IRCCS, 28010 Veruno, Italy; (M.G.); (M.G.)
| | - Antonio Nardone
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy; (M.M.); (R.P.)
- Centro Studi Attività Motorie and Neurorehabilitation and Spinal Units of Pavia Institute, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy
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3
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Mangalam M, Kelty-Stephen DG, Seleznov I, Popov A, Likens AD, Kiyono K, Stergiou N. Older adults and individuals with Parkinson's disease control posture along suborthogonal directions that deviate from the traditional anteroposterior and mediolateral directions. Sci Rep 2024; 14:4117. [PMID: 38374371 PMCID: PMC10876602 DOI: 10.1038/s41598-024-54583-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/14/2024] [Indexed: 02/21/2024] Open
Abstract
A rich and complex temporal structure of variability in postural sway characterizes healthy and adaptable postural control. However, neurodegenerative disorders such as Parkinson's disease, which often manifest as tremors, rigidity, and bradykinesia, disrupt this healthy variability. This study examined postural sway in young and older adults, including individuals with Parkinson's disease, under different upright standing conditions to investigate the potential connection between the temporal structure of variability in postural sway and Parkinsonism. A novel and innovative method called oriented fractal scaling component analysis was employed. This method involves decomposing the two-dimensional center of pressure (CoP) planar trajectories to pinpoint the directions associated with minimal and maximal temporal correlations in postural sway. As a result, it facilitates a comprehensive assessment of the directional characteristics within the temporal structure of sway variability. The results demonstrated that healthy young adults control posture along two orthogonal directions closely aligned with the traditional anatomical anteroposterior (AP) and mediolateral (ML) axes. In contrast, older adults and individuals with Parkinson's disease controlled posture along suborthogonal directions that significantly deviate from the AP and ML axes. These findings suggest that the altered temporal structure of sway variability is evident in individuals with Parkinson's disease and underlies postural deficits, surpassing what can be explained solely by the natural aging process.
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Affiliation(s)
- Madhur Mangalam
- Division of Biomechanics and Research Development, Department of Biomechanics, and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE, 68182, USA.
| | - Damian G Kelty-Stephen
- Department of Psychology, State University of New York at New Paltz, New Paltz, NY, 12561, USA
| | - Ivan Seleznov
- Graduate School of Engineering Science, Osaka University, Osaka, 560-8531, Japan
| | - Anton Popov
- Department of Electronic Engineering, Igor Sikorsky Kyiv Polytechnic Institute, Kyiv, 03056, Ukraine
- Faculty of Applied Sciences, Ukrainian Catholic University, Lviv, 79011, Ukraine
| | - Aaron D Likens
- Division of Biomechanics and Research Development, Department of Biomechanics, and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE, 68182, USA
| | - Ken Kiyono
- Graduate School of Engineering Science, Osaka University, Osaka, 560-8531, Japan
| | - Nick Stergiou
- Division of Biomechanics and Research Development, Department of Biomechanics, and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE, 68182, USA
- Department of Department of Physical Education, and Sport Science, Aristotle University, 570 01, Thessaloniki, Greece
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4
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Heß T, Themann P, Oehlwein C, Milani TL. Does Impaired Plantar Cutaneous Vibration Perception Contribute to Axial Motor Symptoms in Parkinson's Disease? Effects of Medication and Subthalamic Nucleus Deep Brain Stimulation. Brain Sci 2023; 13:1681. [PMID: 38137129 PMCID: PMC10742284 DOI: 10.3390/brainsci13121681] [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: 11/08/2023] [Revised: 11/28/2023] [Accepted: 12/03/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVE To investigate whether impaired plantar cutaneous vibration perception contributes to axial motor symptoms in Parkinson's disease (PD) and whether anti-parkinsonian medication and subthalamic nucleus deep brain stimulation (STN-DBS) show different effects. METHODS Three groups were evaluated: PD patients in the medication "on" state (PD-MED), PD patients in the medication "on" state and additionally "on" STN-DBS (PD-MED-DBS), as well as healthy subjects (HS) as reference. Motor performance was analyzed using a pressure distribution platform. Plantar cutaneous vibration perception thresholds (VPT) were investigated using a customized vibration exciter at 30 Hz. RESULTS Motor performance of PD-MED and PD-MED-DBS was characterized by greater postural sway, smaller limits of stability ranges, and slower gait due to shorter strides, fewer steps per minute, and broader stride widths compared to HS. Comparing patient groups, PD-MED-DBS showed better overall motor performance than PD-MED, particularly for the functional limits of stability and gait. VPTs were significantly higher for PD-MED compared to those of HS, which suggests impaired plantar cutaneous vibration perception in PD. However, PD-MED-DBS showed less impaired cutaneous vibration perception than PD-MED. CONCLUSIONS PD patients suffer from poor motor performance compared to healthy subjects. Anti-parkinsonian medication in tandem with STN-DBS seems to be superior for normalizing axial motor symptoms compared to medication alone. Plantar cutaneous vibration perception is impaired in PD patients, whereas anti-parkinsonian medication together with STN-DBS is superior for normalizing tactile cutaneous perception compared to medication alone. Consequently, based on our results and the findings of the literature, impaired plantar cutaneous vibration perception might contribute to axial motor symptoms in PD.
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Affiliation(s)
- Tobias Heß
- Department of Human Locomotion, Chemnitz University of Technology, 09126 Chemnitz, Germany
| | - Peter Themann
- Department of Neurology and Parkinson, Clinic at Tharandter Forest, 09633 Halsbruecke, Germany
| | - Christian Oehlwein
- Neurological Outpatient Clinic for Parkinson Disease and Deep Brain Stimulation, 07551 Gera, Germany
| | - Thomas L. Milani
- Department of Human Locomotion, Chemnitz University of Technology, 09126 Chemnitz, Germany
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Petel A, Jacob D, Aubonnet R, Frismand S, Petersen H, Gargiulo P, Perrin P. Motion sickness susceptibility and visually induced motion sickness as diagnostic signs in Parkinson's disease. Eur J Transl Myol 2022; 32:10884. [PMID: 36458415 PMCID: PMC9830408 DOI: 10.4081/ejtm.2022.10884] [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: 09/21/2022] [Accepted: 10/06/2022] [Indexed: 12/04/2022] Open
Abstract
Postural instability and loss of vestibular and somatosensory acuity can be part of the signs encountered in Parkinson's Disease (PD). Visual dependency is described in PD. These modifications of sensory input hierarchy are predictors of motion sickness (MS). The aim of this study was to assess MS susceptibility and effects of real induced MS in posture. 63 PD patients, whose medication levels (levodopa) reflected the pathology were evaluated, and 27 healthy controls, filled a MS questionnaire; 9 PD patients and 43 healthy controls were assessed by posturography using virtual reality. Drug amount predicted visual MS (p=0.01), but not real induced MS susceptibility. PD patients did not experience postural instability in virtual reality, contrary to healthy controls. Since PD patients do not seem to feel vestibular stimulated MS, they may not rely on vestibular and somatosensory inputs during the stimulation. However, they feel visually induced MS more with increased levodopa drug effect. Levodopa amount can increase visual dependency. The strongest MS predictors must be studied in PD to better understand the effect of visual stimulation and its absence in vestibular stimulation.
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Affiliation(s)
- Arthur Petel
- EA 3450 DevAH - Development, Adaptation and Handicap, Faculty of Medicine, University of Lorraine, Vandoeuvre-lès-Nancy, France,*These authors contributed equally
| | - Deborah Jacob
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik, Iceland,*These authors contributed equally
| | - Romain Aubonnet
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik, Iceland
| | - Solène Frismand
- Neurology Department, University Hospital of Nancy, Nancy, France
| | - Hannes Petersen
- Department of Anatomy, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland; Akureyri Hospital, Akureyri, Iceland, Department of Science, Landspitali, National University Hospital of Iceland, Reykjavik, Iceland
| | - Paolo Gargiulo
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik, Iceland, Department of Science, Landspitali, National University Hospital of Iceland, Reykjavik, Iceland
| | - Philippe Perrin
- EA 3450 DevAH - Development, Adaptation and Handicap, Faculty of Medicine, University of Lorraine, Vandoeuvre-lès-Nancy, France, Laboratory for the Analysis of Posture, Equilibrium and Motor Function (LAPEM), University Hospital of Nancy, Vandoeuvre-lès-Nancy, France.
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Liu WY, Tung TH, Zhang C, Shi L. Systematic review for the prevention and management of falls and fear of falling in patients with Parkinson's disease. Brain Behav 2022; 12:e2690. [PMID: 35837986 PMCID: PMC9392538 DOI: 10.1002/brb3.2690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/17/2022] [Accepted: 04/24/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To synthesize recent empirical evidence for the prevention and management of falls and fear of falling in patients with Parkinson's disease (PD). DATA SOURCE Database from PubMed, Cochrane Library, and EMBASE. STUDY DESIGN Systematic review. DATA COLLECTION We searched the PubMed, Cochrane Library, and EMBASE databases for studies published from inception to February 27, 2021. Inclusion criteria were nonreview articles on prevention and management measures related to falls and fall prevention in Parkinson's disease patients. PRINCIPAL FINDINGS We selected 45 articles and conducted in-depth research and discussion. According to the causes of falls in PD patients, they were divided into five directions, namely physical status, pre-existing conditions, environment, medical care, and cognition. In the cognitive domain, we focused on the fear of falling. On the above basis, we constructed a fall prevention model, which is a tertiary prevention health care network, based on The Johns Hopkins Fall Risk Assessment Tool to provide ideas for the prevention and management of falling and fear of falling in PD patients in clinical practice CONCLUSIONS: Falls and fear of falls in patients with Parkinson's disease can be reduced by effective clinical prevention and management. Future studies are needed to explore the efficacy of treatment and prevention of falls and fear of falls.
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Affiliation(s)
- Wen-Yi Liu
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.,Shanghai Bluecross Medical Science Institute, Shanghai, China.,Institute for Hospital Management, Tsing Hua University, Shenzhen Campus, China
| | - Tao-Hsin Tung
- Evidence-based Medicine Center, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China
| | - Chencheng Zhang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Leiyu Shi
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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Beylergil SB, Noecker AM, Petersen M, Gupta P, Ozinga S, Walker MF, Kilbane C, McIntyre CC, Shaikh AG. Subthalamic deep brain stimulation affects heading perception in Parkinson's disease. J Neurol 2021; 269:253-268. [PMID: 34003373 DOI: 10.1007/s00415-021-10616-4] [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: 09/26/2020] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 11/25/2022]
Abstract
Parkinson's disease (PD) presents with visuospatial impairment and falls. It is critical to understand how subthalamic deep brain stimulation (STN DBS) modulates visuospatial perception. We hypothesized that DBS has different effects on visual and vestibular perception of linear motion (heading), a critical aspect of visuospatial navigation; and such effects are specific to modulated STN location. Two-alternative forced-choice experiments were performed in 14 PD patients with bilateral STN DBS and 19 age-matched healthy controls (HC) during passive en bloc linear motion and 3D optic-flow in immersive virtual reality measured vestibular and visual heading. Objective measure of perception with Weibull psychometric function revealed that PD has significantly lower accuracy [L: 60.71 (17.86)%, R: 74.82 (17.44)%] and higher thresholds [L: 16.68 (12.83), R: 10.09 (7.35)] during vestibular task in both directions compared to HC (p < 0.05). DBS significantly improved vestibular discrimination accuracy [81.40 (14.36)%] and threshold [4.12 (5.87), p < 0.05] in the rightward direction. There were no DBS effects on the slopes of vestibular psychometric curves. Visual heading perception was better than vestibular and it was comparable to HC. There was no significant effect of DBS on visual heading response accuracy or discrimination threshold (p > 0.05). Patient-specific DBS models revealed an association between change in vestibular heading perception and the modulation of the dorsal STN. In summary, DBS may have different effects on vestibular and visual heading perception in PD. These effects may manifest via dorsal STN putatively by its effects on the cerebellum.
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Affiliation(s)
- Sinem Balta Beylergil
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
- National VA Parkinson Consortium Center, Neurology Service, Daroff-Dell'Osso Ocular Motility and Vestibular Laboratory, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Angela M Noecker
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Mikkel Petersen
- Department of Clinical Medicine-Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
| | - Palak Gupta
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
- National VA Parkinson Consortium Center, Neurology Service, Daroff-Dell'Osso Ocular Motility and Vestibular Laboratory, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Sarah Ozinga
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Mark F Walker
- National VA Parkinson Consortium Center, Neurology Service, Daroff-Dell'Osso Ocular Motility and Vestibular Laboratory, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
- Department of Neurology, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44110, USA
| | - Camilla Kilbane
- Department of Neurology, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44110, USA
- Movement Disorders Center, Neurological Institute, University Hospitals, Cleveland, OH, USA
| | - Cameron C McIntyre
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Aasef G Shaikh
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.
- National VA Parkinson Consortium Center, Neurology Service, Daroff-Dell'Osso Ocular Motility and Vestibular Laboratory, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA.
- Department of Neurology, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44110, USA.
- Movement Disorders Center, Neurological Institute, University Hospitals, Cleveland, OH, USA.
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Genoves GG, Cruz CF, Doná F, Andrade TAM, Ferraz HB, Barela JA. Detection of passive movement in lower limb joints is impaired in individuals with Parkinson's disease. Neurophysiol Clin 2021; 51:279-285. [PMID: 33934993 DOI: 10.1016/j.neucli.2021.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Sensory information is crucial when performing daily activities, and Parkinson's disease may diminish sensitivity to sensory cues. This study aimed to examine the detection threshold of passive motion of knee and ankle joints in individuals with Parkinson's disease. METHODS Eighteen individuals in the early stages of idiopathic Parkinson's disease (age: 62.7 ± 7.3 years) and 18 healthy matched controls (age: 62.5 ± 7.1 years) first performed a simple reaction time test. Participants were asked to perform ten trials, during which they had to watch a square on a screen and press a button as quickly as possible when the square lit up. Thereafter, the participants were tested for their detection threshold of passive motion of their lower limb joints. Participants were seated in a specially designed chair and their knee or ankle joint was passively moved at a velocity of 0.5º/s. Participants kept their eyes closed and were instructed to press a button as quickly as possible when any joint motion was detected. RESULTS Individuals with Parkinson's disease needed more time to perform the reaction time test than did the control participants. Individuals with Parkinson's disease also needed larger angular displacement, even when reaction time was used as a covariate measure, to detect any passive motion, in both knee (0.70º ± 0.20º) and ankle (1.03º ± 0.23º) joints than did the control participants [(0.57º ± 0.20º) and (0.84º ± 0.27º), respectively]. CONCLUSION Impaired joint proprioception can be observed in the early stages of Parkinson's disease, which may compromise the use of proprioception cues from lower limbs.
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Affiliation(s)
- Giovanna Gracioli Genoves
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, São Paulo, SP, Brazil
| | - Caio Ferraz Cruz
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, São Paulo, SP, Brazil; School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, SP, Brazil
| | - Flávia Doná
- Federal University of São Paulo, São Paulo, SP, Brazil
| | | | | | - José Angelo Barela
- Institute of Biosciences, São Paulo State University, Rio Claro, SP, Brazil.
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Halperin O, Karni R, Israeli-Korn S, Hassin-Baer S, Zaidel A. Overconfidence in visual perception in parkinson's disease. Eur J Neurosci 2021; 53:2027-2039. [PMID: 33368717 DOI: 10.1111/ejn.15093] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/04/2020] [Accepted: 12/18/2020] [Indexed: 01/23/2023]
Abstract
Increased dependence on visual cues in Parkinson's disease (PD) can unbalance the perception-action loop, impair multisensory integration, and affect everyday function of PD patients. It is currently unknown why PD patients seem to be more reliant on their visual cues. We hypothesized that PD patients may be overconfident in the reliability (precision) of their visual cues. In this study we tested coherent visual motion perception in PD, and probed subjective (self-reported) confidence in their visual motion perception. Twenty patients with idiopathic PD, 21 healthy aged-matched controls and 20 healthy young adult participants were presented with visual stimuli of moving dots (random dot kinematograms). They were asked to report: (1) whether the aggregate motion of dots was to the left or to the right, and (2) how confident they were that their perceptual discrimination was correct. Visual motion discrimination thresholds were similar (unimpaired) in PD compared to the other groups. By contrast, PD patients were significantly overconfident in their visual perceptual decisions (p = .002 and p < .001 vs. the age-matched and young adult groups, respectively). These results suggest intact visual motion perception, but overestimation of visual cue reliability, in PD. Overconfidence in visual (vs. other, e.g., somatosensory) cues could underlie increased visual dependence and impaired multisensory/sensorimotor integration in PD. It could thereby contribute to gait and balance impairments, and affect everyday activities, such as driving. Future work should investigate and compare PD confidence in somatosensory function. A better understanding of altered sensory reliance might open up new avenues to treat debilitating PD symptoms.
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Affiliation(s)
- Orly Halperin
- Gonda Multidisciplinary Brain Research Center, Bar Ilan University, Ramat Gan, Israel
| | - Roie Karni
- Gonda Multidisciplinary Brain Research Center, Bar Ilan University, Ramat Gan, Israel
| | - Simon Israeli-Korn
- Movement Disorders Institute and the Department of Neurology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Hassin-Baer
- Movement Disorders Institute and the Department of Neurology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adam Zaidel
- Gonda Multidisciplinary Brain Research Center, Bar Ilan University, Ramat Gan, Israel
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Pisupati S, Chartarifsky-Lynn L, Khanal A, Churchland AK. Lapses in perceptual decisions reflect exploration. eLife 2021; 10:55490. [PMID: 33427198 PMCID: PMC7846276 DOI: 10.7554/elife.55490] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 01/10/2021] [Indexed: 12/17/2022] Open
Abstract
Perceptual decision-makers often display a constant rate of errors independent of evidence strength. These ‘lapses’ are treated as a nuisance arising from noise tangential to the decision, e.g. inattention or motor errors. Here, we use a multisensory decision task in rats to demonstrate that these explanations cannot account for lapses’ stimulus dependence. We propose a novel explanation: lapses reflect a strategic trade-off between exploiting known rewarding actions and exploring uncertain ones. We tested this model’s predictions by selectively manipulating one action’s reward magnitude or probability. As uniquely predicted by this model, changes were restricted to lapses associated with that action. Finally, we show that lapses are a powerful tool for assigning decision-related computations to neural structures based on disruption experiments (here, posterior striatum and secondary motor cortex). These results suggest that lapses reflect an integral component of decision-making and are informative about action values in normal and disrupted brain states.
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Affiliation(s)
- Sashank Pisupati
- Cold Spring Harbor Laboratory, Cold Spring Harbor, New York, United States.,CSHL School of Biological Sciences, Cold Spring Harbor, New York, United States
| | - Lital Chartarifsky-Lynn
- Cold Spring Harbor Laboratory, Cold Spring Harbor, New York, United States.,CSHL School of Biological Sciences, Cold Spring Harbor, New York, United States
| | - Anup Khanal
- Cold Spring Harbor Laboratory, Cold Spring Harbor, New York, United States
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11
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Balance alterations and reduction of pedunculopontine cholinergic neurons in early stages of parkinsonism in middle-aged rats. Exp Gerontol 2020; 145:111198. [PMID: 33310153 DOI: 10.1016/j.exger.2020.111198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/21/2020] [Accepted: 12/07/2020] [Indexed: 12/14/2022]
Abstract
The purpose of the present study was to investigate balance alterations and the possible role of the cholinergic neurons in the pedunculopontine nucleus (PPN) in the early stages of a progressive animal model of Parkinson's disease (PD). Twenty-eight middle-aged (8-9 months) male Wistar rats received 4 or 10 subcutaneous vehicle (control, CTL) or reserpine (RES) injections (0.1 mg/kg). The animals were submitted to different behavioral tests. Forty-eight hours after the 4th injection, half of the animals of each group (n = 7) were perfused and submitted to immunohistochemical analysis for tyrosine hydroxylase (TH) and choline acetyltransferase (ChAT). The remaining animals (n = 7 per group) were killed 48 h after the 10th injection. RES group presented motor deficits in the catalepsy and open field tests starting at days 12 and 20 of treatment, respectively (only for the animals that received 10 injections). On the other hand, dynamic and static balance changes were observed at earlier stages of RES treatment, starting at days 6 and 4, respectively. At this point of the treatment, there was no decrease in the number of TH immunoreactivity neurons in the substantia nigra pars compacta (SNpc), ventral tegmental area (VTA) and dorsal striatum (DS). However, a decrease was observed in SNpc and dorsal striatum of animals that received 10 injections. In contrast, there was a decrease in the number of ChAT immunoreactive cells in PPN concomitantly to the balance alterations at the early stages of treatment (after 4 RES injections). Thus, by mimicking the progressiveness of PD, the reserpine model made it possible to identify static and dynamic balance impairments prior to the motor alterations in the catalepsy and open field tests. In addition, changes in balance were accompanied by a reduction in the number of ChAT immunoreactive cells in NPP in the early stages of treatment.
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12
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Beylergil SB, Petersen M, Gupta P, Elkasaby M, Kilbane C, Shaikh AG. Severity‐Dependent Effects of Parkinson's Disease on Perception of Visual and Vestibular Heading. Mov Disord 2020; 36:360-369. [DOI: 10.1002/mds.28352] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 12/22/2022] Open
Affiliation(s)
- Sinem Balta Beylergil
- Department of Biomedical Engineering Case Western Reserve University Cleveland Ohio USA
- National VA Parkinson Consortium Center, Neurology Service, Daroff‐Dell'Osso Ocular Motility and Vestibular Laboratory Louis Stokes Cleveland VA Medical Center Cleveland Ohio USA
| | - Mikkel Petersen
- Department of Clinical Medicine, Center of Functionally Integrative Neuroscience Aarhus University Aarhus Denmark
| | - Palak Gupta
- Department of Biomedical Engineering Case Western Reserve University Cleveland Ohio USA
- National VA Parkinson Consortium Center, Neurology Service, Daroff‐Dell'Osso Ocular Motility and Vestibular Laboratory Louis Stokes Cleveland VA Medical Center Cleveland Ohio USA
| | - Mohamed Elkasaby
- Department of Neurology Case Western Reserve University Cleveland Ohio USA
- Movement Disorders Center, Neurological Institute University Hospitals Cleveland Ohio USA
| | - Camilla Kilbane
- Department of Neurology Case Western Reserve University Cleveland Ohio USA
- Movement Disorders Center, Neurological Institute University Hospitals Cleveland Ohio USA
| | - Aasef G. Shaikh
- Department of Biomedical Engineering Case Western Reserve University Cleveland Ohio USA
- National VA Parkinson Consortium Center, Neurology Service, Daroff‐Dell'Osso Ocular Motility and Vestibular Laboratory Louis Stokes Cleveland VA Medical Center Cleveland Ohio USA
- Department of Neurology Case Western Reserve University Cleveland Ohio USA
- Movement Disorders Center, Neurological Institute University Hospitals Cleveland Ohio USA
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13
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Yakubovich S, Israeli-Korn S, Halperin O, Yahalom G, Hassin-Baer S, Zaidel A. Visual self-motion cues are impaired yet overweighted during visual-vestibular integration in Parkinson's disease. Brain Commun 2020; 2:fcaa035. [PMID: 32954293 PMCID: PMC7425426 DOI: 10.1093/braincomms/fcaa035] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/17/2020] [Accepted: 03/11/2020] [Indexed: 11/25/2022] Open
Abstract
Parkinson's disease is prototypically a movement disorder. Although perceptual and motor functions are highly interdependent, much less is known about perceptual deficits in Parkinson's disease, which are less observable by nature, and might go unnoticed if not tested directly. It is therefore imperative to seek and identify these, to fully understand the challenges facing patients with Parkinson's disease. Also, perceptual deficits may be related to motor symptoms. Posture, gait and balance, affected in Parkinson's disease, rely on veridical perception of one's own motion (self-motion) in space. Yet it is not known whether self-motion perception is impaired in Parkinson's disease. Using a well-established multisensory paradigm of heading discrimination (that has not been previously applied to Parkinson's disease), we tested unisensory visual and vestibular self-motion perception, as well as multisensory integration of visual and vestibular cues, in 19 Parkinson's disease, 23 healthy age-matched and 20 healthy young-adult participants. After experiencing vestibular (on a motion platform), visual (optic flow) or multisensory (combined visual-vestibular) self-motion stimuli at various headings, participants reported whether their perceived heading was to the right or left of straight ahead. Parkinson's disease participants and age-matched controls were tested twice (Parkinson's disease participants on and off medication). Parkinson's disease participants demonstrated significantly impaired visual self-motion perception compared with age-matched controls on both visits, irrespective of medication status. Young controls performed slightly (but not significantly) better than age-matched controls and significantly better than the Parkinson's disease group. The visual self-motion perception impairment in Parkinson's disease correlated significantly with clinical disease severity. By contrast, vestibular performance was unimpaired in Parkinson's disease. Remarkably, despite impaired visual self-motion perception, Parkinson's disease participants significantly overweighted the visual cues during multisensory (visual-vestibular ) integration (compared with Bayesian predictions of optimal integration) and significantly more than controls. These findings indicate that self-motion perception in Parkinson's disease is affected by impaired visual cues and by suboptimal visual-vestibular integration (overweighting of visual cues). Notably, vestibular self-motion perception was unimpaired. Thus, visual self-motion perception is specifically impaired in early-stage Parkinson's disease. This can impact Parkinson's disease diagnosis and subtyping. Overweighting of visual cues could reflect a general multisensory integration deficit in Parkinson's disease, or specific overestimation of visual cue reliability. Finally, impaired self-motion perception in Parkinson's disease may contribute to impaired balance and gait control. Future investigation into this connection might open up new avenues of alternative therapies to better treat these difficult symptoms.
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Affiliation(s)
- Sol Yakubovich
- Gonda Multidisciplinary Brain Research Center, Bar Ilan University, Ramat Gan 5290002, Israel
| | - Simon Israeli-Korn
- Department of Neurology, Movement Disorders Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan 5266202, Israel
- The Neurology and Neurosurgery Department, The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Orly Halperin
- Gonda Multidisciplinary Brain Research Center, Bar Ilan University, Ramat Gan 5290002, Israel
| | - Gilad Yahalom
- Department of Neurology, Movement Disorders Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan 5266202, Israel
- Department of Neurology, Movement Disorders Clinic, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
| | - Sharon Hassin-Baer
- Department of Neurology, Movement Disorders Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan 5266202, Israel
- The Neurology and Neurosurgery Department, The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Adam Zaidel
- Gonda Multidisciplinary Brain Research Center, Bar Ilan University, Ramat Gan 5290002, Israel
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Halperin O, Israeli‐Korn S, Yakubovich S, Hassin‐Baer S, Zaidel A. Self‐motion perception in Parkinson's disease. Eur J Neurosci 2020; 53:2376-2387. [DOI: 10.1111/ejn.14716] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/23/2020] [Accepted: 02/24/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Orly Halperin
- Gonda Multidisciplinary Brain Research Center Bar Ilan University Ramat Gan Israel
| | - Simon Israeli‐Korn
- Department of Neurology Movement Disorders Institute Sheba Medical Center Ramat Gan Israel
- The Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Sol Yakubovich
- Gonda Multidisciplinary Brain Research Center Bar Ilan University Ramat Gan Israel
| | - Sharon Hassin‐Baer
- Department of Neurology Movement Disorders Institute Sheba Medical Center Ramat Gan Israel
- The Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Adam Zaidel
- Gonda Multidisciplinary Brain Research Center Bar Ilan University Ramat Gan Israel
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15
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Bong SM, McKay JL, Factor SA, Ting LH. Perception of whole-body motion during balance perturbations is impaired in Parkinson's disease and is associated with balance impairment. Gait Posture 2020; 76:44-50. [PMID: 31731133 PMCID: PMC7015810 DOI: 10.1016/j.gaitpost.2019.10.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 09/09/2019] [Accepted: 10/22/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND In addition to motor deficits, Parkinson's disease (PD) may cause perceptual impairments. The role of perceptual impairments in sensorimotor function is unclear, and has typically been studied in single-joint motions. RESEARCH QUESTION We hypothesized that perception of whole-body motion is impaired in PD and contributes to balance impairments. We tested (1) whether directional acuity to whole body perturbations during standing was worse in people with PD compared to neurotypical older adults (NOA), and (2) whether balance ability, as assessed by the MiniBESTest, was associated with poor directional acuity in either group. METHODS Participants were exposed to pairs of support-surface translation perturbations in a two-alternative forced choice testing paradigm developed previously in a young healthy population. The first perturbation of each pair that was to be judged by participants was directly backward, and the second perturbation deviated from the left or right from the backward direction by 1°-44°. Participants reported whether the perturbations in each pair were in the "same" or "different" direction. Judgements from 24 to 67 perturbation pairs were used to calculate directional acuity thresholds corresponding to "just-noticeable differences" in perturbation direction. Linear mixed models determined associations between directional thresholds and clinical variables including MDS-UPDRS-III score, age, and MiniBESTest score. RESULTS 20 PD (64 ± 7 y, 12 male, ≥12 h since last intake of antiparkinsonian medications) and 12 NOA (64 ± 8, 6 male) were assessed. Directional thresholds were higher (worse) among PD participants (17.6 ± 5.9° vs. 12.8 ± 3.3°, P < 0.01). Linear mixed models further showed that higher thresholds were associated with MDS-UPDRS-III score (P < 0.01), and were associated with poorer balance ability among PD participants (P < 0.01), but not among NOA participants (P = 0.40). SIGNIFICANCE Perception of whole-body motion is impaired in PD and may contribute to impaired balance and falls.
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Affiliation(s)
- Sistania M. Bong
- Wallace H. Coulter Department of Biomedical Engineering,
Emory University and Georgia Tech, Atlanta, Georgia, USA
| | - J. Lucas McKay
- Wallace H. Coulter Department of Biomedical Engineering,
Emory University and Georgia Tech, Atlanta, Georgia, USA
| | - Stewart A. Factor
- Jean & Paul Amos PD & Movement Disorders Program,
Department of Neurology, Emory University School of Medicine, Atlanta, Georgia,
USA
| | - Lena H. Ting
- Wallace H. Coulter Department of Biomedical Engineering,
Emory University and Georgia Tech, Atlanta, Georgia, USA.,Division of Physical Therapy, Department of Rehabilitation
Medicine, Emory University School of Medicine, Atlanta, Georgia, USA,Corresponding author Lena H. Ting PhD, Wallace H.
Coulter Department of Biomedical Engineering, Emory University and the Georgia
Institute of Technology, 1760 Haygood Drive, Suite W200, Atlanta, Georgia,
30322, USA,
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16
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Beylergil SB, Gupta P, Shaikh AG. Does Inferior-Olive Hypersynchrony Affect Vestibular Heading Perception? THE CEREBELLUM 2020; 20:744-750. [PMID: 31939030 DOI: 10.1007/s12311-020-01103-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Multisensory integration is critical for resolving ambiguities in isolated sensory systems assuring accurate perception of one's own linear motion, i.e., heading. The vestibular signal, a critical source of information for heading perception, is transformed in appropriate coordinates suitable for multisensory integration-such transformation takes place under cerebellar supervision. Deficiency in cerebellar function due to Purkinje cell loss results in inaccurate multisensory integration and impaired heading perception. Here, we predict that a classic movement disorder, the syndrome of oculopalatal tremor (OPT), also presents with inaccurate heading direction perception. The characteristic feature of oculopalatal tremor is pseudohypertrophic inferior olive that constantly sends spontaneous, hypersynchronous, abnormal, and meaningless signals to the cerebellum. Such malicious olive signal can impair heading perception. We examined vestibular heading perception in 6 individuals with OPT and 9 age-matched healthy controls (HC). We used a two-alternative forced choice task performed during passive en bloc translation. Compared with age-matched HC, OPT group had significantly higher heading direction perception threshold indicating a less sensitive vestibular system to variations in heading direction. Using computational simulations, we show that the addition of the abnormal noise into the cerebellar system results in decreased spatiotemporal tuning behavior of the cerebellar output. Such impairment in spatiotemporal tuning causes reduced ability to perceive heading direction. Hyperactivity in the inferior-olive cerebellar pathway impairs the heading direction perception. We suggest that this impairment stems from abnormal noise into the cerebellum due to hypersynchronized inferior olive.
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Affiliation(s)
- Sinem Balta Beylergil
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.,Daroff-Dell'Osso Ocular Motility and Vestibular Laboratory, National VA Parkinson Consortium Center, Neurology Service, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Palak Gupta
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.,Daroff-Dell'Osso Ocular Motility and Vestibular Laboratory, National VA Parkinson Consortium Center, Neurology Service, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Aasef G Shaikh
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA. .,Daroff-Dell'Osso Ocular Motility and Vestibular Laboratory, National VA Parkinson Consortium Center, Neurology Service, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA. .,Department of Neurology, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44110, USA. .,Neurological Institute, University Hospitals, Cleveland, OH, USA.
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17
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Samoudi G, Nilsson A, Carlsson T, Bergquist F. c-Fos Expression after Stochastic Vestibular Stimulation and Levodopa in 6-OHDA Hemilesioned Rats. Neuroscience 2020; 424:146-154. [DOI: 10.1016/j.neuroscience.2019.10.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 11/25/2022]
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18
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Beylergil SB, Ozinga S, Walker MF, McIntyre CC, Shaikh AG. Vestibular heading perception in Parkinson's disease. PROGRESS IN BRAIN RESEARCH 2019; 249:307-319. [PMID: 31325990 DOI: 10.1016/bs.pbr.2019.03.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Postural instability and falls are common causes of morbidity and mortality in the second most prevalent neurodegenerative condition, Parkinson's disease (PD). Poor understanding of balance dysfunction in PD has hampered the development of novel therapeutic measures for postural instability and balance dysfunction. We aimed to determine how the ability to perceive one's own linear motion in the absence of visual cues, i.e., vestibular heading, is affected in PD. We examined vestibular heading function using a two-alternative forced choice task performed on a six-degree-of-freedom motion platform. Sensitivity of the vestibular system to subtle variations in heading direction and systematic errors in accuracy of responses were assessed for each subject using a Gaussian cumulative distribution psychometric function. Compared to healthy subjects, PD presented with higher angular thresholds to detect vestibular heading direction. These results confirm the potential of our study to provide valuable insight to the vestibular system's role in spatial navigation deficits in PD.
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Affiliation(s)
- Sinem Balta Beylergil
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States; National VA Parkinson Consortium Center, Neurology Service, Daroff-Dell'Osso Ocular Motility and Vestibular Laboratory, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States
| | - Sarah Ozinga
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Mark F Walker
- National VA Parkinson Consortium Center, Neurology Service, Daroff-Dell'Osso Ocular Motility and Vestibular Laboratory, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States; Department of Neurology, Case Western Reserve University, Cleveland, OH, United States
| | - Cameron C McIntyre
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Aasef G Shaikh
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States; National VA Parkinson Consortium Center, Neurology Service, Daroff-Dell'Osso Ocular Motility and Vestibular Laboratory, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States; Department of Neurology, Case Western Reserve University, Cleveland, OH, United States; Movement Disorders Center, Neurological Institute, University Hospitals, Cleveland, OH, United States.
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19
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Abstract
For decades it has been speculated that Parkinson's Disease (PD) is associated with dysfunction of the vestibular system, especially given that postural instability is one of the major symptoms of the disorder. Nonetheless, clear evidence of such a connection has been slow to emerge. There are still relatively few studies of the vestibulo-ocular reflexes (VORs) in PD. However, substantial evidence of vestibulo-spinal reflex deficits, in the form of abnormal vestibular-evoked myogenic potentials (VEMPs), now exists. The evidence for abnormalities in the subjective visual vertical is less consistent. However, some studies suggest that the integration of visual and vestibular information may be abnormal in PD. In the last few years, a number of studies have been published which demonstrate that the neuropathology associated with PD, such as Lewy bodies, is present in the central vestibular system. Increasingly, stochastic or noisy galvanic vestibular stimulation (nGVS) is being investigated as a potential treatment for PD, and a number of studies have presented evidence in support of this idea. The aim of this review is to summarize and critically evaluate the human and animal evidence relating to the connection between the vestibular system and PD.
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Affiliation(s)
- Paul F Smith
- Department of Pharmacology and Toxicology, School of Biomedical Sciences and The Brain Health Research Centre, University of Otago, Dunedin, New Zealand.,Brain Research New Zealand Centre of Research Excellence, Eisdell Moore Centre for Hearing and Balance Research, University of Auckland, Auckland, New Zealand
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20
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Cruz CF, Piemonte MEP, Okai-Nobrega LA, Okamoto E, Fortaleza ACDS, Mancini M, Horak FB, Barela JA. Parkinson's disease does not alter automatic visual-motor coupling in postural control. Neurosci Lett 2018; 686:47-52. [PMID: 30193795 DOI: 10.1016/j.neulet.2018.08.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 07/25/2018] [Accepted: 08/31/2018] [Indexed: 11/26/2022]
Abstract
This study examined the coupling between visual information and body sway in patients with Parkinson's disease (PD) compared with healthy controls. Postural control performance was compared between 14 patients with PD (age: 69.6 ± 8.8 years - stages 1-3 of the Hoehn and Yahr scale) and 14 healthy control participants (age: 68.6 ± 3.0 years). Participants stood upright in a moving room that remained motionless or continuously oscillated in the anterior-posterior direction. Ten trials were performed in the following conditions: no movement of the room (1 trial) and with the room moving at frequencies of 0.1, 0.17, and 0.5 Hz (3 trials each frequency). Body sway and moving room displacement were recorded. The results indicated that patients with PD displayed larger body sway magnitude in the stationary room condition. Body sway of patients with PD was induced by visual manipulation in all three visual stimulus frequencies, but body sway of patients with PD was less coherent compared to that of the control participants. However, no difference was observed in the visual-body sway coupling structure. These results indicate that patients with PD can unconsciously couple body sway to visual information in order to control postural sway in a similar manner to healthy participants with intact visual-motor coupling for posture control. However, this coupling is marked by greater variability, indicating that people with PD have a motor system with greater inherent noise leading to a more varied behavior.
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Affiliation(s)
- Caio Ferraz Cruz
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, São Paulo, SP, Brazil; School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, SP, Brazil
| | - Maria Elisa Pimentel Piemonte
- Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil; Brazilian Parkinson Association, São Paulo, SP, Brazil
| | - Líria Akie Okai-Nobrega
- School of Physical Education, Physiotherapy and Occupational Therapy, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Erika Okamoto
- Brazilian Parkinson Association, São Paulo, SP, Brazil
| | | | - Martina Mancini
- Portland Veterans Affairs Health Care Service and Oregon Health and Sciences University, Portland, OR, USA
| | - Fay Bahling Horak
- Portland Veterans Affairs Health Care Service and Oregon Health and Sciences University, Portland, OR, USA
| | - José Angelo Barela
- Institute of Biosciences, São Paulo State University, Rio Claro, SP, Brazil.
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21
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Shaikh AG, Antoniades C, Fitzgerald J, Ghasia FF. Effects of Deep Brain Stimulation on Eye Movements and Vestibular Function. Front Neurol 2018; 9:444. [PMID: 29946295 PMCID: PMC6005881 DOI: 10.3389/fneur.2018.00444] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 05/25/2018] [Indexed: 12/20/2022] Open
Abstract
Discovery of inter-latching circuits in the basal ganglia and invention of deep brain stimulation (DBS) for their modulation is a breakthrough in basic and clinical neuroscience. The DBS not only changes the quality of life of hundreds of thousands of people with intractable movement disorders, but it also offers a unique opportunity to understand how the basal ganglia interacts with other neural structures. An attractive yet less explored area is the study of DBS on eye movements and vestibular function. From the clinical perspective such studies provide valuable guidance in efficient programming of stimulation profile leading to optimal motor outcome. From the scientific standpoint such studies offer the ability to assess the outcomes of basal ganglia stimulation on eye movement behavior in cognitive as well as in motor domains. Understanding the influence of DBS on ocular motor function also leads to analogies to interpret its effects on complex appendicular and axial motor function. This review focuses on the influence of globus pallidus, subthalamic nucleus, and thalamus DBS on ocular motor and vestibular functions. The anatomy and physiology of basal ganglia, pertinent to the principles of DBS and ocular motility, is discussed. Interpretation of the effects of electrical stimulation of the basal ganglia in Parkinson's disease requires understanding of baseline ocular motor function in the diseased brain. Therefore we have also discussed the baseline ocular motor deficits in these patients and how the DBS changes such functions.
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Affiliation(s)
- Aasef G Shaikh
- Department of Neurology, University Hospitals, Case Western Reserve University, Cleveland, OH, United States.,Daroff-Dell'Osso Ocular Motility Laboratory, Cleveland VA Medical Center, Cleveland, OH, United States
| | - Chrystalina Antoniades
- NeuroMetrology Lab, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - James Fitzgerald
- NeuroMetrology Lab, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Fatema F Ghasia
- Daroff-Dell'Osso Ocular Motility Laboratory, Cleveland VA Medical Center, Cleveland, OH, United States.,Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States
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22
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Shaikh AG, Straumann D, Palla A. Motion Illusion-Evidence towards Human Vestibulo-Thalamic Projections. THE CEREBELLUM 2018; 16:656-663. [PMID: 28127679 DOI: 10.1007/s12311-017-0844-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Contemporary studies speculated that cerebellar network responsible for motion perception projects to the cerebral cortex via vestibulo-thalamus. Here, we sought for the physiological properties of vestibulo-thalamic pathway responsible for the motion perception. Healthy subjects and the patient with focal vestibulo-thalamic lacunar stroke spun a hand-held rheostat to approximate the value of perceived angular velocity during whole-body passive earth-vertical axis rotations in yaw plane. Vestibulo-ocular reflex was simultaneously measured with high-resolution search coils (paradigm 1). In primates, the vestibulo-thalamic projections remain medial and then dorsomedial to the subthalamus. Therefore, the paradigm 2 assessed the effects of high-frequency subthalamic nucleus electrical stimulation through the medial and caudal deep brain stimulation electrode in five subjects with Parkinson's disease. Paradigm 1 discovered directional mismatch of perceived rotation in a patient with vestibulo-thalamic lacune. There was no such mismatch in vestibulo-ocular reflex. Healthy subjects did not have such directional discrepancy of perceived motion. The results confirmed that perceived angular motion is relayed through the thalamus. Stimulation through medial and caudal-most electrode of subthalamic deep brain stimulator in paradigm 2 resulted in perception of rotational motion in the horizontal semicircular canal plane. One patient perceived riding a swing, a complex motion, possibly the combination of vertical canal and otolith-derived signals representing pitch and fore-aft motion, respectively. The results examined physiological properties of the vestibulo-thalamic pathway that passes in proximity to the subthalamic nucleus conducting pure semicircular canal signals and convergent signals from the semicircular canals and the otoliths.
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Affiliation(s)
- Aasef G Shaikh
- Department of Neurology, Case Western Reserve University, Cleveland, OH, USA. .,Neurology Service, Cleveland VA Medical Center, Cleveland, OH, USA. .,Daroff-DelOsso Ocular Motility Laboratory, Cleveland VA Medical Center, Cleveland, OH, USA. .,Department of Neurology, University Hospitals, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44110, USA.
| | - Dominik Straumann
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Antonella Palla
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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23
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Darbin O, Gubler C, Naritoku D, Dees D, Martino A, Adams E. Parkinsonian Balance Deficits Quantified Using a Game Industry Board and a Specific Battery of Four Paradigms. Front Hum Neurosci 2016; 10:431. [PMID: 27625601 PMCID: PMC5003866 DOI: 10.3389/fnhum.2016.00431] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 08/11/2016] [Indexed: 11/13/2022] Open
Abstract
This study describes a cost-effective screening protocol for parkinsonism based on combined objective and subjective monitoring of balance function. Objective evaluation of balance function was performed using a game industry balance board and an automated analyses of the dynamic of the center of pressure in time, frequency, and non-linear domains collected during short series of stand up tests with different modalities and severity of sensorial deprivation. The subjective measurement of balance function was performed using the Dizziness Handicap Inventory questionnaire. Principal component analyses on both objective and subjective measurements of balance function allowed to obtained a specificity and selectivity for parkinsonian patients (vs. healthy subjects) of 0.67 and 0.71 respectively. The findings are discussed regarding the relevance of cost-effective balance-based screening system as strategy to meet the needs of broader and earlier screening for parkinsonism in communities with limited access to healthcare.
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Affiliation(s)
- Olivier Darbin
- Department of Neurology, University of South AlabamaMobile, AL, USA
- Division of System Neurophysiology, National Institute for Physiological SciencesOkazaki, Japan
- Animal Resource Program, University of Alabama at BirminghamBirmingham, AL, USA
- Vestibular Research, University of South AlabamaMobile, AL, USA
| | - Coral Gubler
- Vestibular Research, University of South AlabamaMobile, AL, USA
- Department of Physical Therapy, University of South AlabamaMobile, AL, USA
| | - Dean Naritoku
- Department of Neurology, University of South AlabamaMobile, AL, USA
| | - Daniel Dees
- Department of Neurology, University of South AlabamaMobile, AL, USA
| | - Anthony Martino
- Department of Neurosurgery, University of South AlabamaMobile, AL, USA
| | - Elizabeth Adams
- Vestibular Research, University of South AlabamaMobile, AL, USA
- Department of Speech Pathology and Audiology, University of South AlabamaMobile, AL, USA
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Bertolini G, Straumann D. Moving in a Moving World: A Review on Vestibular Motion Sickness. Front Neurol 2016; 7:14. [PMID: 26913019 PMCID: PMC4753518 DOI: 10.3389/fneur.2016.00014] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 02/01/2016] [Indexed: 11/13/2022] Open
Abstract
Motion sickness is a common disturbance occurring in healthy people as a physiological response to exposure to motion stimuli that are unexpected on the basis of previous experience. The motion can be either real, and therefore perceived by the vestibular system, or illusory, as in the case of visual illusion. A multitude of studies has been performed in the last decades, substantiating different nauseogenic stimuli, studying their specific characteristics, proposing unifying theories, and testing possible countermeasures. Several reviews focused on one of these aspects; however, the link between specific nauseogenic stimuli and the unifying theories and models is often not clearly detailed. Readers unfamiliar with the topic, but studying a condition that may involve motion sickness, can therefore have difficulties to understand why a specific stimulus will induce motion sickness. So far, this general audience struggles to take advantage of the solid basis provided by existing theories and models. This review focuses on vestibular-only motion sickness, listing the relevant motion stimuli, clarifying the sensory signals involved, and framing them in the context of the current theories.
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Affiliation(s)
- Giovanni Bertolini
- Department of Neurology, University Hospital Zurich , Zurich , Switzerland
| | - Dominik Straumann
- Department of Neurology, University Hospital Zurich , Zurich , Switzerland
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Correia C, Lopez KJ, Wroblewski KE, Huisingh-Scheetz M, Kern DW, Chen RC, Schumm LP, Dale W, McClintock MK, Pinto JM. Global Sensory Impairment in Older Adults in the United States. J Am Geriatr Soc 2016; 64:306-313. [PMID: 26889840 PMCID: PMC4808743 DOI: 10.1111/jgs.13955] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To determine whether there may be a common mechanism resulting in global sensory impairment of the five classical senses (vision, smell, hearing, touch, and taste) in older adults. DESIGN Representative, population-based study. SETTING National Social Life, Health, and Aging Project. PARTICIPANTS Community-dwelling U.S. adults aged 57 to 85. MEASUREMENTS The frequency with which impairment co-occurred across the five senses was estimated as an integrated measure of sensory aging. It was hypothesized that multisensory deficits would be common and reflect global sensory impairment that would largely explain the effects of age, sex, and race on sensory dysfunction. RESULTS Two-thirds of subjects had two or more sensory deficits, 27% had just one, and 6% had none. Seventy-four percent had impairment in taste, 70% in touch, 22% in smell, 20% in corrected vision, and 18% in corrected hearing. Older adults, men, African Americans, and Hispanics had greater multisensory impairment (all P < .01). Global sensory impairment largely accounted for the effects of age, sex, and race on the likelihood of impairment in each of the five senses. CONCLUSION Multisensory impairment is prevalent in older U.S. adults. These data support the concept of a common process that underlies sensory aging across the five senses. Clinicians assessing individuals with a sensory deficit should consider further evaluation for additional co-occurring sensory deficits.
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Chiba R, Takakusaki K, Ota J, Yozu A, Haga N. Human upright posture control models based on multisensory inputs; in fast and slow dynamics. Neurosci Res 2015; 104:96-104. [PMID: 26746115 DOI: 10.1016/j.neures.2015.12.002] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 11/29/2015] [Accepted: 12/01/2015] [Indexed: 12/22/2022]
Abstract
Posture control to maintain an upright stance is one of the most important and basic requirements in the daily life of humans. The sensory inputs involved in posture control include visual and vestibular inputs, as well as proprioceptive and tactile somatosensory inputs. These multisensory inputs are integrated to represent the body state (body schema); this is then utilized in the brain to generate the motion. Changes in the multisensory inputs result in postural alterations (fast dynamics), as well as long-term alterations in multisensory integration and posture control itself (slow dynamics). In this review, we discuss the fast and slow dynamics, with a focus on multisensory integration including an introduction of our study to investigate "internal force control" with multisensory integration-evoked posture alteration. We found that the study of the slow dynamics is lagging compared to that of fast dynamics, such that our understanding of long-term alterations is insufficient to reveal the underlying mechanisms and to propose suitable models. Additional studies investigating slow dynamics are required to expand our knowledge of this area, which would support the physical training and rehabilitation of elderly and impaired persons.
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Affiliation(s)
- Ryosuke Chiba
- Research Center for Brain Function and Medical Engineering, Asahikawa Medical University, Japan.
| | - Kaoru Takakusaki
- Research Center for Brain Function and Medical Engineering, Asahikawa Medical University, Japan
| | - Jun Ota
- Research into Artifacts, Center for Engineering (RACE), The University of Tokyo, Japan
| | - Arito Yozu
- Department of Rehabilitation Medicine, Graduate School of Medicine, The University of Tokyo, Japan
| | - Nobuhiko Haga
- Department of Rehabilitation Medicine, Graduate School of Medicine, The University of Tokyo, Japan
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