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Maron C, Jendre A, Goble D, Marks C, Haworth J. Acute Knee Crutch Use Provokes Changes to Postural Strategy. Percept Mot Skills 2024; 131:805-817. [PMID: 38613514 DOI: 10.1177/00315125241246390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2024]
Abstract
Single-leg knee crutches are a relatively new, hands-free mobility assistive device with benefits over standard axillary crutches. Our main goal in this study was to evaluate balance ability in a healthy population upon first exposure to the knee crutch device. We had 20 healthy individuals (M age = 21.1; SD = 1.5 years) complete baseline static and dynamic balance tests on a force plate, followed by knee crutch fitting, a self-selected duration of ambulation practice, and another round of balance testing while wearing the knee crutch. We used the BTrackS Balance Test (BBT) to measure static balance, and the BTrackS Limits of Stability (BLOS) test to measure dynamic balance, and we created a custom lateral bias score from the BLOS results. On average, participants self-selected 3.1 minutes of ambulation practice. Wearing the knee crutch caused a near doubling of static balance path length and a large reduction in percentile ranking on the BBT. Dynamic balance area was more than halved (p < .001), with lateral bias scores during the BLOS, indicating that participants heavily favored their non-crutched leg (p < .001). Our results indicate that static and dynamic balance were significantly altered when wearing the knee crutch, and participants seemed to switch to a single leg stance strategy. Despite these balance changes, participants were quickly ready and willing to complete independent ambulation and balance testing procedures using the single-leg knee crutch.
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Affiliation(s)
- Christian Maron
- Department of Human Movement Science, Oakland University, Rochester, MI, USA
| | - Aron Jendre
- Department of Human Movement Science, Oakland University, Rochester, MI, USA
| | - Daniel Goble
- Department of Human Movement Science, Oakland University, Rochester, MI, USA
| | - Charles Marks
- Department of Human Movement Science, Oakland University, Rochester, MI, USA
| | - Joshua Haworth
- Department of Human Movement Science, Oakland University, Rochester, MI, USA
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Camargo CHF, Ferreira-Peruzzo SA, Ribas DIR, Franklin GL, Teive HAG. Imbalance and gait impairment in Parkinson's disease: discussing postural instability and ataxia. Neurol Sci 2024; 45:1377-1388. [PMID: 37985635 DOI: 10.1007/s10072-023-07205-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/14/2023] [Indexed: 11/22/2023]
Abstract
Gait and balance difficulties pose significant clinical challenges in Parkinson's disease (PD). The impairment of physiological mechanisms responsible for maintaining natural orthostatism plays a central role in the pathophysiology of postural instability observed in PD. In addition to the well-known rigidity and abnormalities in muscles and joints, various brain regions involved in the regulation of posture, balance, and gait, such as the basal ganglia, cerebellum, and brainstem regions like the pontine peduncle nucleus, are affected in individuals with PD. The recognition of the cerebellum's role in PD has been increasingly acknowledged. Cortical areas and their connections are associated with freezing of gait, a type of frontal lobe ataxia commonly observed in PD. Furthermore, impairments in the peripheral nervous system, including those caused by levodopatherapy, can contribute to gait impairment and imbalance in PD patients. Consequently, individuals with PD may exhibit frontal ataxia, sensory ataxia, and even cerebellar ataxia as underlying causes of gait disturbances and imbalance, starting from the early stages of the disease. The complex interplay between dysfunctional brain regions, impaired cortical connections, and peripheral nervous system abnormalities contributes to the multifaceted nature of gait and balance difficulties in PD. Understanding the intricate mechanisms is crucial for the development of effective therapeutic approaches targeting these specific deficits in PD.
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Affiliation(s)
- Carlos Henrique F Camargo
- Neurological Diseases Group, Postgraduate Program in Internal Medicine, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Paraná, 80060-900, Brazil.
| | - Silvia Aparecida Ferreira-Peruzzo
- Neurological Diseases Group, Postgraduate Program in Internal Medicine, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Paraná, 80060-900, Brazil
- School of Health Sciences, Autonomous University of Brazil, Curitiba, Paraná, Brazil
| | - Danieli Isabel Romanovitch Ribas
- Neurological Diseases Group, Postgraduate Program in Internal Medicine, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Paraná, 80060-900, Brazil
- School of Health Sciences, Autonomous University of Brazil, Curitiba, Paraná, Brazil
| | - Gustavo L Franklin
- School of Medicine, Pontifical Catholic University of Paraná, Curitiba, Paraná, Brazil
| | - Hélio A G Teive
- Neurological Diseases Group, Postgraduate Program in Internal Medicine, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Paraná, 80060-900, Brazil
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Paraná, Brazil
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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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Silvia Aparecida FP, Carlos Henrique Ferreira C, Marise Bueno Z, Pessoa Renata R, Renato Puppi M, Hélio Afonso Ghizoni T. Static posturography analysis for postural instability in patients with Parkinson's disease. Int J Neurosci 2023:1-13. [PMID: 37873603 DOI: 10.1080/00207454.2023.2273765] [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: 06/22/2023] [Accepted: 10/17/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Parkinson's disease (PD) is initially characterized by a rigid-akinetic syndrome and later by the development of postural instability. This condition often leads to balance impairments, potentially resulting in postural deformities and foot asymmetry. This study aimed to assess balance changes in PD patients. METHODS We evaluated 56 PD patients and 30 controls using static posturography. The variables examined included foot type, the primary region of body weight distribution on the plantar surface, statokinesigram (center of pressure [COP]), and stabilogram (COP in the X- and Y-axes). RESULTS PD patients exhibited a high prevalence of pes cavus (92.8%) (p < 0.001) and greater weight distribution toward the hindfoot. In all assessments, COP sway areas were significantly larger in PD patients (p < 0.001). The total COP area increased in the non-fall group during the foot parallel assessment and in the X-axis in the fall group with eyes open (p = 0.046) and closed (p = 0.023). Significant correlations between body weight discharge on the plantar area and COP sway were observed, particularly in the non-postural instability group in the COP X-axis with feet parallel and eyes open on the more rigid limb and in the postural instability group in the Y-axis with feet parallel and eyes open on the more rigid limb and with eyes closed bilaterally. CONCLUSION Progressive rigidity may disrupt compensatory mechanisms, altering foot morphology, shifting body weight discharge posteriorly, and increasing COP sway. This cascade of events results in impaired balance and an elevated risk of falls.
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Affiliation(s)
- Ferreira-Peruzzo Silvia Aparecida
- Neurological Diseases Group, Postgraduate Program in Internal Medicine, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
- School of Health Sciences, Autonomous University of Brazil, Curitiba, Brazil
- Ergonomics Laboratory, Federal University of Technology of Paraná, Curitiba, Brazil
| | - Camargo Carlos Henrique Ferreira
- Neurological Diseases Group, Postgraduate Program in Internal Medicine, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Zonta Marise Bueno
- Neurological Diseases Group, Postgraduate Program in Internal Medicine, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Curitiba, Brazil
| | | | - Munhoz Renato Puppi
- Gloria and Morton Shulman Movement Disorders Centre, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Teive Hélio Afonso Ghizoni
- Neurological Diseases Group, Postgraduate Program in Internal Medicine, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Curitiba, Brazil
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Legutke BR, Gobbi LTB, Orcioli-Silva D, Santos PCRD, Moraca GAG, Vitório R, Beretta VS. Transcranial direct current stimulation suggests not improving postural control during adapted tandem position in people with Parkinson's disease: A pilot study. Behav Brain Res 2023; 452:114581. [PMID: 37453515 DOI: 10.1016/j.bbr.2023.114581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 07/07/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Balance impairments in people with Parkinson's disease (PD) demonstrated mainly in challenging postural tasks, such as increased body oscillation may be attributed to the deficits in the brain structures functionality involved in postural control (e.g., motor cortex, midbrain, and brainstem). Although promising results, the effect of transcranial direct current stimulation (tDCS) on postural control in people with PD is unclear, especially in objective measures such as the center of pressure (CoP) parameters. Thus, we analyzed the effects of a single session of tDCS on the CoP parameters during the adapted tandem position in people with PD. METHODS Nineteen people with PD participated in this crossover, randomized, and double-blind study. Anodal tDCS was applied over the primary motor cortex in two conditions of stimulation (2 mA/active and sham) on two different days for 20 min immediately before the postural control evaluation. Participants remained standing in an adapted tandem position for the postural control assessment for 30 s (three trials). CoP parameters were acquired by a force plate. RESULTS No significant differences were demonstrated between stimulation conditions (p-value range = 0.15-0.89). CONCLUSIONS Our results suggested that a single session of tDCS with 2 mA does not improve the postural control of people with PD during adapted tandem.
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Affiliation(s)
- Beatriz Regina Legutke
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Graduate Program in Movement Sciences, São Paulo State University - UNESP, Brazil
| | - Diego Orcioli-Silva
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; University of Campinas (UNICAMP), School of Applied Sciences (FCA), Laboratory of Applied Sport Physiology (LAFAE), Limeira, Brazil
| | - Paulo Cezar Rocha Dos Santos
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Israel; The Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Israel
| | - Gabriel Antonio Gazziero Moraca
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Graduate Program in Movement Sciences, São Paulo State University - UNESP, Brazil
| | - Rodrigo Vitório
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Victor Spiandor Beretta
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Graduate Program in Movement Sciences, São Paulo State University - UNESP, Brazil; São Paulo State University (Unesp), School of Technology and Sciences, Presidente Prudente, São Paulo, Brazil.
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Heß T, Oehlwein C, Milani TL. Anticipatory Postural Adjustments and Compensatory Postural Responses to Multidirectional Perturbations-Effects of Medication and Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease. Brain Sci 2023; 13:brainsci13030454. [PMID: 36979264 PMCID: PMC10046463 DOI: 10.3390/brainsci13030454] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Postural instability is one of the most restricting motor symptoms for patients with Parkinson's disease (PD). While medication therapy only shows minor effects, it is still unclear whether medication in conjunction with deep brain stimulation (DBS) of the subthalamic nucleus (STN) improves postural stability. Hence, the aim of this study was to investigate whether PD patients treated with medication in conjunction with STN-DBS have superior postural control compared to patients treated with medication alone. METHODS Three study groups were tested: PD patients on medication (PD-MED), PD patients on medication and on STN-DBS (PD-MED-DBS), and healthy elderly subjects (HS) as a reference. Postural performance, including anticipatory postural adjustments (APA) prior to perturbation onset and compensatory postural responses (CPR) following multidirectional horizontal perturbations, was analyzed using force plate and electromyography data. RESULTS Regardless of the treatment condition, both patient groups showed inadequate APA and CPR with early and pronounced antagonistic muscle co-contractions compared to healthy elderly subjects. Comparing the treatment conditions, study group PD-MED-DBS only showed minor advantages over group PD-MED. In particular, group PD-MED-DBS showed faster postural reflexes and tended to have more physiological co-contraction ratios. CONCLUSION medication in conjunction with STN-DBS may have positive effects on the timing and amplitude of postural control.
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Affiliation(s)
- Tobias Heß
- Department of Human Locomotion, Chemnitz University of Technology, 09126 Chemnitz, 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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Faria MH, Simieli L, Rietdyk S, Penedo T, Santinelli FB, Barbieri FA. (A)symmetry during gait initiation in people with Parkinson's disease: A motor and cortical activity exploratory study. Front Aging Neurosci 2023; 15:1142540. [PMID: 37139089 PMCID: PMC10150081 DOI: 10.3389/fnagi.2023.1142540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/28/2023] [Indexed: 05/05/2023] Open
Abstract
Background Gait asymmetry and deficits in gait initiation (GI) are among the most disabling symptoms in people with Parkinson's disease (PwPD). Understanding if PwPD with reduced asymmetry during GI have higher asymmetry in cortical activity may provide support for an adaptive mechanism to improve GI, particularly in the presence of an obstacle. Objective This study quantified the asymmetry of anticipatory postural adjustments (APAs), stepping parameters and cortical activity during GI, and tested if the presence of an obstacle regulates asymmetry in PwPD. Methods Sixteen PwPD and 16 control group (CG) performed 20-trials in two conditions: unobstructed and obstructed GI with right and left limbs. We measured, through symmetry index, (i) motor parameters: APAs and stepping, and (ii) cortical activity: the PSD of the frontal, sensorimotor and occipital areas during APA, STEP-I (moment of heel-off of the leading foot in the GI until the heel contact of the same foot); and STEP-II (moment of the heel-off of the trailing foot in the GI until the heel contact of the same foot) phases. Results Parkinson's disease showed higher asymmetry in cortical activity during APA, STEP-I and STEP-II phases and step velocity (STEP-II phase) during unobstructed GI than CG. However, unexpectedly, PwPD reduced the level of asymmetry of anterior-posterior displacement (p < 0.01) and medial-lateral velocity (p < 0.05) of the APAs. Also, when an obstacle was in place, PwPD showed higher APAs asymmetry (medial-lateral velocity: p < 0.002), with reduced and increased asymmetry of the cortical activity during APA and STEP-I phases, respectively. Conclusion Parkinson's disease were not motor asymmetric during GI, indicating that higher cortical activity asymmetry can be interpreted as an adaptive behavior to reduce motor asymmetry. In addition, the presence of obstacle did not regulate motor asymmetry during GI in PwPD.
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Affiliation(s)
- Murilo Henrique Faria
- Human Movement Research Laboratory (MOVI-LAB), School of Sciences, Department of Physical Education, São Paulo State University (Unesp), Bauru, São Paulo, Brazil
| | - Lucas Simieli
- Human Movement Research Laboratory (MOVI-LAB), School of Sciences, Department of Physical Education, São Paulo State University (Unesp), Bauru, São Paulo, Brazil
| | - Shirley Rietdyk
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, United States
| | - Tiago Penedo
- Human Movement Research Laboratory (MOVI-LAB), School of Sciences, Department of Physical Education, São Paulo State University (Unesp), Bauru, São Paulo, Brazil
| | - Felipe Balistieri Santinelli
- Human Movement Research Laboratory (MOVI-LAB), School of Sciences, Department of Physical Education, São Paulo State University (Unesp), Bauru, São Paulo, Brazil
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Fabio Augusto Barbieri
- Human Movement Research Laboratory (MOVI-LAB), School of Sciences, Department of Physical Education, São Paulo State University (Unesp), Bauru, São Paulo, Brazil
- *Correspondence: Fabio Augusto Barbieri,
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Costa EDC, Santinelli FB, Moretto GF, Figueiredo C, von Ah Morano AE, Barela JA, Barbieri FA. A multiple domain postural control assessment in people with Parkinson's disease: traditional, non-linear, and rambling and trembling trajectories analysis. Gait Posture 2022; 97:130-136. [PMID: 35932689 DOI: 10.1016/j.gaitpost.2022.07.250] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/06/2022] [Accepted: 07/24/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Postural impairment is one of the most debilitating symptoms in people with Parkinson's disease (PD), which show faster and more variable oscillation during quiet stance than neurologically healthy individuals. Despite the center of pressure parameters can characterize PD's body sway, they are limited to uncover underlying mechanisms of postural stability and instability. RESEARCH QUESTION Do a multiple domain analysis, including postural adaptability and rambling and trembling components, explain underlying postural stability and instability mechanisms in people with PD? METHOD Twenty-four individuals (12 people with PD and 12 neurologically healthy peers) performed three 60-s trials of upright quiet standing on a force platform. Traditional and non-linear parameters (Detrended Fluctuation Analysis- DFA and Multiscale Entropy- MSE) and rambling and trembling trajectories were calculated for anterior-posterior (AP) and medial-lateral (ML) directions. RESULTS PDG's postural control was worse compared to CG, displaying longer displacement, higher velocity, and RMS. Univariate analyses revealed largely longer displacement and RMS only for the AP direction and largely higher velocity for both AP and ML directions. Also, PD individuals showed lower AP complexity, higher AP and ML DFA, and increased AP and ML displacement, velocity, and RMS of rambling and trembling components compared to neurologically healthy individuals. SIGNIFICANCE Based upon these results, people with PD have a lower capacity to adapt posture and impaired both rambling and trembling components compared to neurologically healthy individuals. These findings provide new insights to explain the larger, faster, and more variable sway in people with PD.
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Affiliation(s)
- Elisa de Carvalho Costa
- São Paulo State University (Unesp), School of Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, SP, Brazil
| | - Felipe Balistieri Santinelli
- São Paulo State University (Unesp), School of Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, SP, Brazil; REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Gabriel Felipe Moretto
- São Paulo State University (Unesp), School of Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, SP, Brazil
| | - Caique Figueiredo
- São Paulo State University (Unesp), School of Technology and Sciences, Department of Physical Education, Physical Education, Exercise and Immunometabolism Research Group, Presidente Prudente, SP, Brazil
| | - Ana Elisa von Ah Morano
- São Paulo State University (Unesp), School of Technology and Sciences, Department of Physical Education, Physical Education, Exercise and Immunometabolism Research Group, Presidente Prudente, SP, Brazil
| | - José Angelo Barela
- São Paulo State University (Unesp) - Institute of Biosciences, Department of Physical Education, Campus Rio Claro, SP, Brazil
| | - Fabio Augusto Barbieri
- São Paulo State University (Unesp), School of Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, SP, Brazil.
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da Conceição NR, de Souza CR, Júlia ÁDO, de Lima-Pardini AC, Silva-Batista C, Teixeira LA, Coelho DB. Between-leg asymmetry in automatic postural responses to stance perturbations in people with Parkinson's disease. Gait Posture 2022; 97:40-42. [PMID: 35872481 DOI: 10.1016/j.gaitpost.2022.07.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 07/11/2022] [Accepted: 07/17/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND People with Parkinson's disease (PwPD) showed impairments of balance control which can be aggravated by the presence of higher interlateral postural asymmetry caused by a distinct dopaminergic loss in the substantia nigra between cerebral hemispheres. RESEARCH QUESTION We evaluate asymmetries between the more and the less affected leg in PwPD in responses to unanticipated stance perturbations. METHODS Sixteen 16 PwPD participated in the experiment that consisted of recovering a stable upright stance, keeping the feet in place, in response to a perturbation caused by a sudden release of a load equivalent to 7 % of the participant's body mass. Anterior displacement and velocity of the center of pressure (CoP), the latency of gastrocnemius medialis muscle (GM) activation onset, rate of GM activation, and normalized magnitude of muscular activation were analyzed. RESULTS Analysis revealed significantly rate (p = 0.04) and magnitude (p = 0.02) higher activation of GM in the less affected limb. No significant effects of the leg were found for GM activation latency or CoP-related variables. SIGNIFICANCE There is a higher contribution of the less affected leg in automatic postural responses in PwPD.
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Affiliation(s)
- Núbia Ribeiro da Conceição
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Caroline Ribeiro de Souza
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Ávila de Oliveira Júlia
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | | | - Carla Silva-Batista
- Exercise Neuroscience Research Group, School of Arts, Sciences, and Humanities, University of São Paulo, São Paulo, Brazil
| | - Luis Augusto Teixeira
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Daniel Boari Coelho
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil; Biomedical Engineering, Federal University of ABC, São Bernardo do Campo, São Paulo, Brazil.
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10
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Corradini JR, Silveira-Ciola AP, Pereira VAI, Kuroda MH, Faria MH, Simieli L, Tavares JMRS, Barbieri FA. Dual tasking reduces gait asymmetry of trajectory deviation during obstacle circumvention in people with Parkinson's disease. Hum Mov Sci 2022; 83:102938. [PMID: 35276426 DOI: 10.1016/j.humov.2022.102938] [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: 05/18/2021] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Certain aspects of gait may depend on cognition, and the effects of dual-tasking (DT) on gait asymmetry (GA) during obstacle circumvention in people with Parkinson's disease (pwPD) may be walking phase-dependent. While the approaching phase requires allocating significant cognitive resources to perform the task, outweighing the available resources may increase GA. During the avoiding phase, the obstacle could be used as an external cue, enhancing the attention to the obstacle and, consequently, improving gait control and regulating GA. OBJECTIVE The study investigated the effects of obstacle circumvention during gait with DT on GA in pwPD, considering the circumvention phase. METHODS Thirty participants, 15 pwPD and 15 neurologically healthy individuals, circumvented an obstacle 20 times (in total) according to side (right and left side) and DT (presence and absence). Spatial-temporal stride parameters, medial-lateral and horizontal trajectory deviations from the original path, strategy to obstacle circumvention (lead limb away from or close to the obstacle during the crossing step), and gaze parameters were calculated during the approaching and avoiding phases. The parameters were grouped considering the side that the obstacle was circumvented during each task, and the symmetry index was calculated. RESULTS The results showed greater asymmetry of time of fixations, width, duration, and velocity during the approaching phase (p < 0.02), whereas the avoiding phase decreased asymmetry of medial-lateral and horizontal trajectory deviations parameters (p < 0.001) during obstacle circumvention with DT, in both pwPD and control group. CONCLUSIONS The findings offer a basis for considering that goal-directed movement control may regulate GA in pwPD.
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Affiliation(s)
- Julia R Corradini
- São Paulo State University (Unesp), School of Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, SP, Brazil
| | - Aline P Silveira-Ciola
- São Paulo State University (Unesp), School of Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, SP, Brazil
| | - Vinicius A I Pereira
- São Paulo State University (Unesp), School of Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, SP, Brazil; University of South Australia - Education Future Academic Unit, Australia
| | - Marina H Kuroda
- São Paulo State University (Unesp), School of Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, SP, Brazil
| | - Murilo H Faria
- São Paulo State University (Unesp), School of Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, SP, Brazil
| | - Lucas Simieli
- São Paulo State University (Unesp), School of Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, SP, Brazil
| | - João Manuel R S Tavares
- Instituto de Ciência e Inovação em Engenharia Mecânica e Engenharia Industrial, Departamento de Engenharia Mecânica, Faculdade de Engenharia, Universidade do Porto, Porto, Portugal
| | - Fabio A Barbieri
- São Paulo State University (Unesp), School of Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, SP, Brazil.
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11
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Śliwowski R, Marynowicz J, Jadczak Ł, Grygorowicz M, Kalinowski P, Paillard T. The relationships between knee extensors/ flexors strength and balance control in elite male soccer players. PeerJ 2021; 9:e12461. [PMID: 34820190 PMCID: PMC8603814 DOI: 10.7717/peerj.12461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/18/2021] [Indexed: 11/20/2022] Open
Abstract
Background Strength and balance are important factors for soccer players to be successful. This study’s aim was to determine the relationship between lower-limb muscle strength and balance control in elite male soccer players (n = 77). Methods Concentric isokinetic strength (peak torque of quadriceps (PT-Q) and hamstrings (PT-H), hamstrings/quadriceps (H/Q) ratio) was measured for the dominant and non-dominant leg at angular velocities of 60°s−1and 240°s−1, as well as the total work for extensors (TW-Q) and flexors (TW-H) for both legs (at an angular velocity of 240°s−1only). Balance score (BAL score) was used for unilateral assessment of balance control using a Delos Postural System Test measurement tool. Hierarchical multiple regression analyses were performed to predict balance control using isokinetic knee strength performance for dominant and non-dominant legs. Results Final modelling included peak torque of hamstrings at 240°s−1 and peak torque of the quadriceps at 240°s−1 for the non-dominant leg (R2 = 19.6%; p ≤ 0.001) and only peak hamstring torque at 240°s−1 for the dominant leg (R2 = 11.3%; p = 0.003) as significant predictors of balance score. Conclusion Findings indicate that balance control is widely influenced by peak hamstring torque and peak quadriceps torque at high angular velocity particularly in the non-dominant leg i.e., the supporting leg in soccer players.
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Affiliation(s)
- Robert Śliwowski
- Department of Theory and Methodology of Team Sport Games, Poznan University of Physical Education, Poznan, Poland
| | - Jakub Marynowicz
- Department of Theory and Methodology of Team Sport Games, Poznan University of Physical Education, Poznan, Poland
| | - Łukasz Jadczak
- Department of Theory and Methodology of Team Sport Games, Poznan University of Physical Education, Poznan, Poland
| | - Monika Grygorowicz
- Department of Physiotherapy, Poznań University of Medical Sciences, Poznan, Poland.,Rehasport Clinic FIFA Medical Centre of Excellence, Poznan, Poland
| | - Paweł Kalinowski
- Department of Theory and Methodology of Team Sport Games, Poznan University of Physical Education, Poznan, Poland
| | - Thierry Paillard
- Department of Sport Sciences, University of Pau et des Pays de l'Adour, E2S UPPA, MEPS Laboratory, Tarbes, France
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12
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Beretta VS, Carpenter MG, Barbieri FA, Santos PCR, Orcioli-Silva D, Pereira MP, Gobbi LTB. Does the impaired postural control in Parkinson's disease affect the habituation to non-sequential external perturbation trials? Clin Biomech (Bristol, Avon) 2021; 85:105363. [PMID: 33932865 DOI: 10.1016/j.clinbiomech.2021.105363] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 03/02/2021] [Accepted: 04/19/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND How people with Parkinson's disease habituate their postural response to unpredictable translation perturbation is not totally understood. We compared the capacity to change the postural responses after unexpected external perturbation and investigated the habituation plateaus of postural responses to non-sequential perturbation trials in people with Parkinson's disease and healthy older adults. METHODS In people with Parkinson's disease (n = 37) and older adults (n = 20), sudden posterior support-surface translational were applied in 7 out of 17 randomized trials to ensure perturbation unpredictability. Electromyography and center of pressure parameters of postural response were analyzed by ANOVAs (Group vs. Trials). Two simple planned contrasts were performed to determine at which trial the responses first significantly habituate, and by which trials the habituation plateaus. FINDINGS Older adults demonstrated a first response change in trial 5 and habituation plateaus after trial 4, while for people with Parkinson's disease, the first change occurred in trial 2 and habituation plateau after trial 5 observed by center of pressure range. People with Parkinson's disease demonstrated a greater center of pressure range in trial 1 compared to older adults. Independent of trial, people with Parkinson's disease vs. older adults demonstrated a greater ankle muscle co-activation and recovery time. INTERPRETATION Despite the greater center of pressure range in the first trial, people with Parkinson's disease can habituate to unpredictable perturbations. This is reflected by little, to no difference in the time-course of adaptation for all but 2 parameters that showed only marginal differences between people with Parkinson's disease and older adults.
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Affiliation(s)
- Victor Spiandor Beretta
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Mark Gregory Carpenter
- School of Kinesiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Fabio Augusto Barbieri
- São Paulo State University (Unesp), School of Sciences, Graduate Program in Movement Sciences, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Paulo Cezar Rocha Santos
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Diego Orcioli-Silva
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Marcelo Pinto Pereira
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil.
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13
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Moraca GAG, Beretta VS, Dos Santos PCR, Nóbrega-Sousa P, Orcioli-Silva D, Vitório R, Gobbi LTB. Center of pressure responses to unpredictable external perturbations indicate low accuracy in predicting fall risk in people with Parkinson's disease. Eur J Neurosci 2021; 53:2901-2911. [PMID: 33561905 DOI: 10.1111/ejn.15143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 11/29/2022]
Abstract
Falls are associated with impairment in postural control in people with Parkinson's disease (PwPD). We aimed to predict the fall risk through models combining postural responses with clinical and cognitive measures. Also, we compared the center of pressure (CoP) between PwPD fallers and non-fallers after unpredictable external perturbations. We expected that CoP parameters combined with clinical and cognitive measures would predict fall risk. Seventy-five individuals participated in the study. CoP parameters were measured during postural responses through five trials with unpredictable translations of the support-surface in posterior direction. Range and peak of CoP were analyzed in two periods: early and late responses. Time to peak (negative peak) and recovery time were analyzed regardless of the periods. Models included the CoP parameters in early (model 1), late responses (model 2), and temporal parameters (model 3). Clinical and cognitive measures were entered into all models. Twenty-nine participants fell at least once, and 46 PwPD did not fall during 12 months following the postural assessment. Range of CoP in late responses was associated with fall risk (p = .046). However, although statistically non-significant, this parameter indicated low accuracy in predicting fall risk (area under the curve = 0.58). Fallers presented a higher range of CoP in early responses than non-fallers (p = .033). In conclusion, although an association was observed between fall risk and range of CoP in late responses, this parameter indicated low accuracy in predicting fall risk in PwPD. Also, fallers demonstrate worse postural control during early responses after external perturbations than non-fallers, measured by CoP parameters.
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Affiliation(s)
- Gabriel Antonio Gazziero Moraca
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Rio Claro, Brazil
| | - Victor Spiandor Beretta
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Rio Claro, Brazil.,Graduate Program in Movement Sciences, São Paulo State University (Unesp), Rio Claro, Brazil
| | - Paulo Cezar Rocha Dos Santos
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Rio Claro, Brazil.,Graduate Program in Movement Sciences, São Paulo State University (Unesp), Rio Claro, Brazil.,Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Priscila Nóbrega-Sousa
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Rio Claro, Brazil.,Graduate Program in Movement Sciences, São Paulo State University (Unesp), Rio Claro, Brazil
| | - Diego Orcioli-Silva
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Rio Claro, Brazil.,Graduate Program in Movement Sciences, São Paulo State University (Unesp), Rio Claro, Brazil
| | - Rodrigo Vitório
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Rio Claro, Brazil.,Graduate Program in Movement Sciences, São Paulo State University (Unesp), Rio Claro, Brazil.,Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Lilian Teresa Bucken Gobbi
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Rio Claro, Brazil.,Graduate Program in Movement Sciences, São Paulo State University (Unesp), Rio Claro, Brazil
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14
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Moretto GF, Santinelli FB, Penedo T, Mochizuki L, Rinaldi NM, Barbieri FA. Prolonged Standing Task Affects Adaptability of Postural Control in People With Parkinson's Disease. Neurorehabil Neural Repair 2020; 35:58-67. [PMID: 33241729 DOI: 10.1177/1545968320971739] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Studies on short-term upright quiet standing tasks have presented contradictory findings about postural control in people with Parkinson's disease (pwPD). Prolonged trial durations might better depict body sway and discriminate pwPD and controls. OBJECTIVE The aim of this study was to investigate postural control in pwPD during a prolonged standing task. METHODS A total of 26 pwPD and 25 neurologically healthy individuals performed 3 quiet standing trials (60 s) before completing a constrained prolonged standing task for 15 minutes. Motion capture was used to record body sway (Vicon, 100 Hz). To investigate the body sway behavior during the 15 minutes of standing, the analysis was divided into three 5-minute-long phases: early, middle, and late. The following body sway parameters were calculated for the anterior-posterior (AP) and medial-lateral (ML) directions: velocity, root-mean-square, and detrended fluctuations analysis (DFA). The body sway area was also calculated. Two-way ANOVAs (group and phases) and 1-way ANOVA (group) were used to compare these parameters for the prolonged standing and quiet standing, respectively. RESULTS pwPD presented smaller sway area (P < .001), less complexity (DFA; AP: P < .009; ML: P < .01), and faster velocity (AP: P < .002; ML: P < .001) of body sway compared with the control group during the prolonged standing task. Although the groups swayed similarly (no difference for sway area) during quiet standing, they presented differences in sway area during the prolonged standing task (P < .001). CONCLUSIONS Prolonged standing task reduced adaptability of the postural control system in pwPD. In addition, the prolonged standing task may better analyze the adaptability of the postural control system in pwPD.
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Affiliation(s)
| | | | - Tiago Penedo
- São Paulo State University (UNESP), Bauru, Brazil
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15
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Does monopedal postural balance differ between the dominant leg and the non-dominant leg? A review. Hum Mov Sci 2020; 74:102686. [PMID: 33059226 DOI: 10.1016/j.humov.2020.102686] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 01/02/2023]
Abstract
The interlimb postural comparison i.e., between the dominant leg and the non-dominant leg has been studied by numerous authors but their results are contradictory and do not lead to a consensus. Some studies showed no difference of postural balance between the dominant and the non-dominant leg whereas other studies concluded that the dominant and non-dominant leg exhibit different postural balance in healthy subjects and athletes. The aim was to analyse all these studies in order to identify the different factors that could facilitate or prevent the appearance of a postural difference between the dominant and non-dominant leg by means of a narrative review. Environmental and experimental conditions (e.g., difficulty and specificity of postural tasks; physiological state, expertise level and moment of season/period over career of subjects/athletes evaluated and nature of sport/physical activity practiced; techniques and methods used for measuring postural balance) in which postural balance is evaluated and intrinsic/individual factors (e.g., morphology, strength/power muscle, proprioception, hemispheric laterality) could influence the results. Thus, the influence of limb dominance on monopedal postural balance would probably be context-dependent. Mechanistic explanations are proposed to explain how each factor could act on the relationship between limb dominance and postural balance. However many mechanisms have not yet been explained and all the factors have not been identified, which suggests that further exploratory research is needed in order to understand this relationship.
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16
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Beretta VS, Vitório R, Nóbrega-Sousa P, Conceição NR, Orcioli-Silva D, Pereira MP, Gobbi LTB. Effect of Different Intensities of Transcranial Direct Current Stimulation on Postural Response to External Perturbation in Patients With Parkinson’s Disease. Neurorehabil Neural Repair 2020; 34:1009-1019. [DOI: 10.1177/1545968320962513] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Habituation of postural response to perturbations is impaired in people with Parkinson’s disease (PD) due to deficits in cortico-basal pathways. Although transcranial direct current stimulation (tDCS) modulate cortico-basal networks, it remains unclear if it can benefit postural control in PD. Objective To analyze the effect of different intensities of anodal tDCS on postural responses and prefrontal cortex (PFC) activity during the habituation to the external perturbation in patients with PD (n = 24). Methods Anodal tDCS was applied over the primary motor cortex (M1) with 1 mA, 2 mA, and sham stimulation in 3 different sessions (~2 weeks apart) during 20 minutes immediately before the postural assessment. External perturbation (7 trials) was applied by a support base posterior translation (20 cm/s and 5 cm). Primary outcome measures included lower limb electromyography and center of pressure parameters. Measures of PFC activity are reported as exploratory outcomes. Analyses of variance (Stimulation Condition × Trial) were performed. Results Habituation of perturbation was evidenced independent of the stimulation conditions. Both active stimulation intensities had shorter recovery time and a trend for lower cortical activity in the stimulated hemisphere when compared to sham condition. Shorter onset latency of the medial gastrocnemius as well as lower cortical activity in the nonstimulated hemisphere were only observed after 2 mA concerning the sham condition. Conclusions tDCS over M1 improved the postural response to external perturbation in PD, with better response observed for 2 mA compared with 1 mA. However, tDCS seems to be inefficient in modifying the habituation of perturbation.
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Affiliation(s)
- Victor Spiandor Beretta
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
| | - Rodrigo Vitório
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
- Oregon Health & Science University, Portland, OR, USA
| | - Priscila Nóbrega-Sousa
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
| | - Núbia Ribeiro Conceição
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
| | - Diego Orcioli-Silva
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
| | - Marcelo Pinto Pereira
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
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17
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Spagnolo F, Rini AM, Guida P, Longobardi S, Battista P, Passarella B. The Choice of Leg During Pull Test in Parkinson's Disease: Not Mere Chance. Front Neurol 2020; 11:302. [PMID: 32477234 PMCID: PMC7238876 DOI: 10.3389/fneur.2020.00302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 03/30/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Parkinson's disease (PD) starts asymmetrically and it maintains a certain degree of asymmetry throughout its course. Once functional disability proceeds, people with PD can change their dominant hand due to the increased disease severity. This is particularly true for hand dominance, while no studies have been performed so far exploring the behavioral changes of lower limb utilization in PD according to the lateralized symptom dominance. In the current study, we aim to track the foot preference of participants with PD to respond to the Pull Test. Methods: Forty-one subjects suffering from PD, with a H&Y scale ≤ 2, were recruited. A motor evaluation was performed, including the motor part of the MDS-UPDRS, its axial and lateralized scores (for more and less affected side), two Timed Tests, namely Time to Walk a standard distance (TW, in seconds) and Time Up and Go Test (TUG, in seconds), and the Pull Test. The preferred foot (right or left) involved in the step backward was recorded. Thirty-seven healthy controls underwent a motor assessment which included the Pull Test and the Timed Tests. Both participants with PD and controls were right-handed. To evaluate the relationship between the response to Pull-Test and PD-symptoms, subjects with PD were further divided into two groups: (1) Right more affected side (Right-MAS), and (2) Left more affected side (Left-MAS). Results: Both groups of subjects with PD (Right-MAS and Left-MAS) during the Pull Test shifted significantly their leg use preference toward the opposite side than the more affected side: Right-MAS used preferentially their left leg (71%) and vice versa (p < 0.001). The limb preference shift was especially true for Left-MAS group that almost invariably used their right, dominant leg to respond to the Pull Test (95%). Similar results were obtained comparing people with PD and Controls. Conclusions: This study shows that the limb used to respond to the Pull Test generally predicts the contralateral side of worse PD involvement. As the disease takes place, it prevails over hemispheric dominance: right-handed subjects with left side PD-onset and worse lateralization tend to be hyper-right-dominant, while right-handed subjects with right side PD-onset and worse impairment tend to behave as left-handers. Lateralization of symptoms in PD is still a mysterious phenomenon; more studies are needed to better understand this association and to optimize tailored rehabilitation programs for people with PD.
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Affiliation(s)
| | | | - Pietro Guida
- Scientific Clinical Institute Maugeri SPA SB, IRCCS, Institute of Cassano Murge, Bari, Italy
| | - Sara Longobardi
- Neurological Department, Antonio Perrino's Hospital, Brindisi, Italy
| | - Petronilla Battista
- Scientific Clinical Institute Maugeri SPA SB, IRCCS, Institute of Cassano Murge, Bari, Italy
| | - Bruno Passarella
- Neurological Department, Antonio Perrino's Hospital, Brindisi, Italy
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18
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Park H, Youm C, Lee M, Noh B, Cheon SM. Turning Characteristics of the More-Affected Side in Parkinson's Disease Patients with Freezing of Gait. SENSORS 2020; 20:s20113098. [PMID: 32486303 PMCID: PMC7309092 DOI: 10.3390/s20113098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 11/16/2022]
Abstract
This study investigated the turning characteristics of the more-affected limbs in Parkinson's disease (PD) patients in comparison with that of a control group, and in PD patients with freezing of gait (FOG; freezers) in comparison with those without FOG (non-freezers) for 360° and 540° turning tasks at the maximum speed. A total of 12 freezers, 12 non-freezers, and 12 controls participated in this study. The PD patients showed significantly longer total durations, shorter inner and outer step lengths, and greater anterior-posterior (AP) root mean square (RMS) center of mass (COM) distances compared to those for the controls. The freezers showed significantly greater AP and medial-lateral (ML) RMS COM distances compared to those of non-freezers. The turning task toward the inner step of the more-affected side (IMA) in PD patients showed significantly greater step width, total steps, and AP and ML RMS COM distances than that toward the outer step of the more-affected side (OMA). The corresponding results for freezers revealed significantly higher total steps and shorter inner step length during the 540° turn toward the IMA than that toward the OMA. Therefore, PD patients and freezers exhibited greater turning difficulty in performing challenging turning tasks such as turning with an increased angle and speed and toward the more-affected side.
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Affiliation(s)
- Hwayoung Park
- Biomechanics Laboratory, College of Health Sciences, Dong-A University, Busan 49315, Korea; (H.P.); (M.L.)
| | - Changhong Youm
- Biomechanics Laboratory, College of Health Sciences, Dong-A University, Busan 49315, Korea; (H.P.); (M.L.)
- Department of Healthcare and Science, College of Health Sciences, Dong-A University, Busan 49315, Korea;
- Correspondence: ; Tel.: +82-51-200-7830; Fax: +82-51-200-7505
| | - Myeounggon Lee
- Biomechanics Laboratory, College of Health Sciences, Dong-A University, Busan 49315, Korea; (H.P.); (M.L.)
| | - Byungjoo Noh
- Department of Healthcare and Science, College of Health Sciences, Dong-A University, Busan 49315, Korea;
| | - Sang-Myung Cheon
- Department of Neurology, School of Medicine, Dong-A University, Dongdaesin-dong 3-ga, Seo-gu, Busan 49315, Korea;
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19
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Double obstacles increase gait asymmetry during obstacle crossing in people with Parkinson's disease and healthy older adults: A pilot study. Sci Rep 2020; 10:2272. [PMID: 32042027 PMCID: PMC7010667 DOI: 10.1038/s41598-020-59266-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 01/27/2020] [Indexed: 11/17/2022] Open
Abstract
Gait asymmetry during unobstructed walking in people with Parkinson’s disease (PD) has been well documented. However, under complex situations, such as environments with double obstacles, gait asymmetry remains poorly understood in PD. Therefore, the aim of this study was to analyze inter-limb asymmetry while crossing a single obstacle and double obstacles (with different distances between them) in people with PD and healthy older adults. Nineteen people with PD and 19 healthy older people performed three conditions: (i) walking with one obstacle (Single); (ii) walking with two obstacles with a 50 cm distance between them (Double-50); (iii) walking with two obstacles with a 108 cm distance between them (Double-108). The participants performed the obstacle crossing with both lower limbs. Asymmetry Index was calculated. We found that people with PD presented higher leading and trailing toe clearance asymmetry than healthy older people. In addition, participants increased asymmetry in the Double-50 compared to Single condition. It can be concluded that people with PD show higher asymmetry during obstacle crossing compared to healthy older people, independently of the number of obstacles. In addition, a challenging environment induces asymmetry during obstacle crossing in both people with PD and healthy older people.
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20
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Shin C, Ahn TB. Asymmetric dynamic center-of-pressure in Parkinson's disease. J Neurol Sci 2020; 408:116559. [PMID: 31710970 DOI: 10.1016/j.jns.2019.116559] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 10/24/2019] [Accepted: 10/31/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Gait disturbance gradually worsens as Parkinson's disease (PD) progresses, which significantly affects the quality of life of PD patients. Treadmill-based gait analysis systems can measure gait parameters including the dynamic center-of-pressure (COP) trajectory during ambulation. In this study, we hypothesized that altered dynamic COP changes are new gait characteristics for PD patients. METHODS Dynamic COP parameters and classic spatiotemporal parameters were obtained for each patient using a treadmill-based system at the maximal comfortable treadmill speed (MCTS). We compared dynamic COP parameters between 44 PD patients and 31 controls, correlated these parameters with clinical and spatiotemporal data, and adjusted for age and MCTS to determine whether the parameters were independent from the treadmill speed. We also evaluated characteristics of COP parameters in relation to the more and less affected sides in PD patients. RESULTS During treadmill walking the length of the COP trajectory in the stance phase was decreased, an effect that was more prominent on the more affected side in PD patients. COP parameters related to this change were significantly altered in patients when compared to controls. Asymmetry of the COP trajectories compared between both feet was identified as a significant gait characteristic after adjusting for age and MCTS. The overlaid graphical display of dynamic COP trajectory in PD patients showed "distorted butterfly with asymmetric wing" feature. CONCLUSION Dynamic COP asymmetry provides a new and intuitive way to analyze gait abnormalities of PD patients. Further studies with prospective designs will substantiate the clinical usefulness of this feature of gait.
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Affiliation(s)
- Chaewon Shin
- Department of Neurology, Chungnam National University Hospital, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Tae-Beom Ahn
- Department of Neurology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
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21
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Barbieri FA, Carpenter M, Beretta VS, Orcioli-Silva D, Simieli L, Vitório R, Gobbi LTB. Postural control, falls and Parkinson’s disease: Are fallers more asymmetric than non-fallers? Hum Mov Sci 2019; 63:129-137. [DOI: 10.1016/j.humov.2018.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 10/10/2018] [Accepted: 10/17/2018] [Indexed: 10/27/2022]
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22
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Cabeleira MEP, Pagnussat AS, Pinho AS, Asquidamini ACD, Freire AB, Pereira BT, Mello Rieder CR, Schifino GP, Fornari LHT, Junior NDS, Corrêa PS, Cechetti F. Impairments in gait kinematics and postural control may not correlate with dopamine transporter depletion in individuals with mild to moderate Parkinson's disease. Eur J Neurosci 2019; 49:1640-1648. [DOI: 10.1111/ejn.14328] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/29/2018] [Accepted: 12/21/2018] [Indexed: 01/08/2023]
Affiliation(s)
| | - Aline Souza Pagnussat
- Federal University of Health Sciences of Porto AlegrePost‐Graduation Program in Rehabilitation Sciences Porto Alegre Brazil
- Federal University of Health Sciences of Porto AlegrePost‐Graduation Program in Health Sciences Porto Alegre Brazil
| | - Alexandre Severo Pinho
- Federal University of Health Sciences of Porto AlegrePost‐Graduation Program in Health Sciences Porto Alegre Brazil
| | - Ane Caroline Dotta Asquidamini
- Federal University of Health Sciences of Porto AlegrePost‐Graduation Program in Rehabilitation Sciences Porto Alegre Brazil
| | - Ariane Bolla Freire
- Federal University of Health Sciences of Porto AlegrePost‐Graduation Program in Rehabilitation Sciences Porto Alegre Brazil
| | - Brenda Tubelo Pereira
- Federal University of Health Sciences of Porto AlegrePost‐Graduation Program in Rehabilitation Sciences Porto Alegre Brazil
| | - Carlos Roberto Mello Rieder
- Federal University of Health Sciences of Porto AlegrePost‐Graduation Program in Rehabilitation Sciences Porto Alegre Brazil
- Federal University of Health Sciences of Porto AlegrePost‐Graduation Program in Health Sciences Porto Alegre Brazil
| | - Giulia Palermo Schifino
- Federal University of Health Sciences of Porto AlegrePost‐Graduation Program in Rehabilitation Sciences Porto Alegre Brazil
| | - Luis Henrique Tieppo Fornari
- Federal University of Health Sciences of Porto AlegrePost‐Graduation Program in Rehabilitation Sciences Porto Alegre Brazil
| | | | - Philipe Souza Corrêa
- Federal University of Health Sciences of Porto AlegrePost‐Graduation Program in Rehabilitation Sciences Porto Alegre Brazil
| | - Fernanda Cechetti
- Federal University of Health Sciences of Porto AlegrePost‐Graduation Program in Rehabilitation Sciences Porto Alegre Brazil
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Abstract
This study aimed to determine the relationship between postural asymmetry and falls in Parkinson's disease (PD). In total, 28 patients with PD were included. Postural control was analyzed in bipedal, tandem, and unipedal standing. Center of pressure (CoP) parameters were calculated for both limbs, and asymmetry was assessed using the asymmetry index. Logistic regression was used to predict/classify fallers through postural asymmetry. The Spearman correlation was performed to relate asymmetry and falls number. Poisson regression models were created to predict the number of falls in each condition. The results demonstrated that asymmetry can classify 75% of fallers and nonfallers. Asymmetry in anteroposterior-mean velocity of CoP in unipedal standing was related to the number of falls. Poisson regression showed that anteroposterior-mean velocity of CoP predicts falls in PD, indicating that increased asymmetry results in a greater number of falls. Anteroposterior-mean velocity of CoP seems to be a sensitive parameter to detect falls in PD, mainly during a postural challenging task.
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Barbieri FA, Polastri PF, Gobbi LTB, Simieli L, Pereira VIA, Baptista AM, Moretto GF, Fiorelli CM, Imaizumi LFI, Rodrigues ST. Obstacle circumvention and eye coordination during walking to least and most affected side in people with Parkinson's disease. Behav Brain Res 2018; 346:105-114. [PMID: 29180136 DOI: 10.1016/j.bbr.2017.11.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 11/23/2017] [Accepted: 11/23/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND The mechanisms that contribute to gait asymmetry in people with Parkinson's disease (PD) are unclear, mainly during gait with greater environmental demand, such as when an obstacle is circumvented while walking. OBJECTIVE The aim of this study was to investigate the effects of obstacle circumvention of the least and most affected side on motor and gaze behavior in people with PD under/without the effects of dopaminergic medication. METHODS Fifteen people with PD and 15 matched-control individuals were instructed to walk along a pathway, at a self-selected velocity, and to circumvent an obstacle, avoiding contact with it. Each participant performed five trials for each side. Kinematic parameters, mediolateral and horizontal body clearance to the obstacle, strategy to circumvent the obstacle, and gaze behavior were calculated. Parameters were grouped according to the side that the obstacle was circumvented and compared by three-way ANOVAs. RESULTS Both people with PD and the control group presented asymmetry to circumvent an obstacle during walking, however this was exacerbated in people with PD. Individuals with PD presented safe strategies (largest mediolateral and horizontal body clearance to the obstacle, "lead-out" strategy, and higher number and time of fixations on the obstacle) during obstacle circumvention for the least affected side compared to the most affected side. In addition, positive effects of dopaminergic medication on body clearance, spatial-temporal parameters, and gaze behavior were evidenced only when the obstacle was circumvented to the least affected side. CONCLUSIONS The obstacle circumvention to the most affected side is risky for people with PD.
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Affiliation(s)
- Fabio Augusto Barbieri
- São Paulo State University (Unesp) - Campus Bauru, Scholl of Science, Human Movement Research Laboratory (MOVI-LAB) and Laboratory of Information, Vision and Action (LIVIA), Department of Physical Education, Bauru, SP, Brazil.
| | - Paula Favaro Polastri
- São Paulo State University (Unesp) - Campus Bauru, Scholl of Science, Human Movement Research Laboratory (MOVI-LAB) and Laboratory of Information, Vision and Action (LIVIA), Department of Physical Education, Bauru, SP, Brazil
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (Unesp), Campus Rio Claro, Posture and Gait Studies Laboratory (LEPLO), Department of Physical Education, Rio Claro, SP, Brazil
| | - Lucas Simieli
- São Paulo State University (Unesp) - Campus Bauru, Scholl of Science, Human Movement Research Laboratory (MOVI-LAB) and Laboratory of Information, Vision and Action (LIVIA), Department of Physical Education, Bauru, SP, Brazil
| | - Vinicius Ignácio Alota Pereira
- São Paulo State University (Unesp) - Campus Bauru, Scholl of Science, Human Movement Research Laboratory (MOVI-LAB) and Laboratory of Information, Vision and Action (LIVIA), Department of Physical Education, Bauru, SP, Brazil
| | - André Macari Baptista
- São Paulo State University (Unesp) - Campus Bauru, Scholl of Science, Human Movement Research Laboratory (MOVI-LAB) and Laboratory of Information, Vision and Action (LIVIA), Department of Physical Education, Bauru, SP, Brazil
| | - Gabriel Felipe Moretto
- São Paulo State University (Unesp) - Campus Bauru, Scholl of Science, Human Movement Research Laboratory (MOVI-LAB) and Laboratory of Information, Vision and Action (LIVIA), Department of Physical Education, Bauru, SP, Brazil
| | - Carolina Menezes Fiorelli
- São Paulo State University (Unesp) - Campus Bauru, Scholl of Science, Human Movement Research Laboratory (MOVI-LAB) and Laboratory of Information, Vision and Action (LIVIA), Department of Physical Education, Bauru, SP, Brazil; Universidade Sagrado Coração, Bauru, SP, Brazil
| | - Luis Felipe Itikawa Imaizumi
- São Paulo State University (Unesp) - Campus Bauru, Scholl of Science, Human Movement Research Laboratory (MOVI-LAB) and Laboratory of Information, Vision and Action (LIVIA), Department of Physical Education, Bauru, SP, Brazil
| | - Sérgio Tosi Rodrigues
- São Paulo State University (Unesp) - Campus Bauru, Scholl of Science, Human Movement Research Laboratory (MOVI-LAB) and Laboratory of Information, Vision and Action (LIVIA), Department of Physical Education, Bauru, SP, Brazil
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25
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Riederer P, Jellinger KA, Kolber P, Hipp G, Sian-Hülsmann J, Krüger R. Lateralisation in Parkinson disease. Cell Tissue Res 2018; 373:297-312. [PMID: 29656343 DOI: 10.1007/s00441-018-2832-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 03/21/2018] [Indexed: 01/11/2023]
Abstract
Asymmetry of dopaminergic neurodegeneration and subsequent lateralisation of motor symptoms are distinctive features of Parkinson's disease compared to other forms of neurodegenerative or symptomatic parkinsonism. Even 200 years after the first description of the disease, the underlying causes for this striking clinicopathological feature are not yet fully understood. There is increasing evidence that lateralisation of disease is due to a complex interplay of hereditary and environmental factors that are reflected not only in the concept of dominant hemispheres and handedness but also in specific susceptibilities of neuronal subpopulations within the substantia nigra. As a consequence, not only the obvious lateralisation of motor symptoms occurs but also patterns of associated non-motor signs are defined, which include cognitive functions, sleep behaviour or olfaction. Better understanding of the mechanisms contributing to lateralisation of neurodegeneration and the resulting patterns of clinical phenotypes based on bilateral post-mortem brain analyses and clinical studies focusing on right/left hemispheric symptom origin will help to develop more targeted therapeutic approaches, taking into account subtypes of PD as a heterogeneous disorder.
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Affiliation(s)
- P Riederer
- Center of Mental Health, Clinic and Policlinic for Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany. .,Psychiatry Department of Clinical Research, University of Southern Denmark, Odense University Hospital, J.B. Winsløws Vej 18, Indgang 220 A, DK-5000, Odense C, Denmark.
| | - K A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, A-1150, Vienna, Austria
| | - P Kolber
- Parkinson Research Clinic, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - G Hipp
- Parkinson Research Clinic, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - J Sian-Hülsmann
- Department of Medical Physiology, University of Nairobi, PO Box 30197, Nairobi, 00100, Kenya
| | - R Krüger
- Parkinson Research Clinic, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
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26
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Barbieri FA, Simieli L, Orcioli-Silva D, Baptista AM, Borkowske Pestana M, Spiandor Beretta V, Dos Santos PCR, Bucken Gobbi LT. Obstacle Avoidance Increases Asymmetry of Crossing Step in Individuals With Parkinson's Disease and Neurologically Healthy Individuals. J Mot Behav 2017. [PMID: 28632105 DOI: 10.1080/00222895.2016.1271303] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The authors' aim was to investigate gait asymmetry of crossing step during obstacle avoidance while walking in people with Parkinson's disease (PD) under and without the effects of dopaminergic medication. Thirteen individuals with PD and 13 neurologically healthy individuals performed 5 trials of unobstructed gait and 10 trials of obstacle crossing during gait (5 trials with each leg) and spatiotemporal parameters were analyzed. Obstacle crossing increased step duration of the crossing step for the most-affected or nondominant limb compared to the crossing step with the least-affected or dominant limb. Individuals with PD without the effects of medication increased step duration for the step with the least-affected limb compared to the step with the most-affected limb during obstacle crossing.
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Affiliation(s)
- Fabio Augusto Barbieri
- a Human Movement Research Laboratory (MOVI-LAB), Faculty of Science, Department of Physical Education , Universidade Estadual Paulista-UNESP , Bauru , Brazil.,b Posture and Gait Studies Laboratory (LEPLO), Bioscience Institute, Department of Physical Education , Universidade Estadual Paulista-UNESP , Rio Claro , Brazil
| | - Lucas Simieli
- b Posture and Gait Studies Laboratory (LEPLO), Bioscience Institute, Department of Physical Education , Universidade Estadual Paulista-UNESP , Rio Claro , Brazil
| | - Diego Orcioli-Silva
- b Posture and Gait Studies Laboratory (LEPLO), Bioscience Institute, Department of Physical Education , Universidade Estadual Paulista-UNESP , Rio Claro , Brazil
| | - André Macari Baptista
- a Human Movement Research Laboratory (MOVI-LAB), Faculty of Science, Department of Physical Education , Universidade Estadual Paulista-UNESP , Bauru , Brazil.,b Posture and Gait Studies Laboratory (LEPLO), Bioscience Institute, Department of Physical Education , Universidade Estadual Paulista-UNESP , Rio Claro , Brazil
| | - Mayara Borkowske Pestana
- b Posture and Gait Studies Laboratory (LEPLO), Bioscience Institute, Department of Physical Education , Universidade Estadual Paulista-UNESP , Rio Claro , Brazil
| | - Victor Spiandor Beretta
- b Posture and Gait Studies Laboratory (LEPLO), Bioscience Institute, Department of Physical Education , Universidade Estadual Paulista-UNESP , Rio Claro , Brazil
| | - Paulo Cezar Rocha Dos Santos
- b Posture and Gait Studies Laboratory (LEPLO), Bioscience Institute, Department of Physical Education , Universidade Estadual Paulista-UNESP , Rio Claro , Brazil
| | - Lilian Teresa Bucken Gobbi
- b Posture and Gait Studies Laboratory (LEPLO), Bioscience Institute, Department of Physical Education , Universidade Estadual Paulista-UNESP , Rio Claro , Brazil
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27
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Almeida IAD, Terra MB, Oliveira MRD, Silva Júnior RAD, Ferraz HB, Santos SMS. Comparing postural balance among older adults and Parkinson's disease patients. MOTRIZ: REVISTA DE EDUCACAO FISICA 2016. [DOI: 10.1590/s1980-6574201600040007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Terra MB, Rosa PC, Torrecilha LA, Costa BT, Ferraz HB, Santos SMS. Impacto da doença de Parkinson na performance do equilíbrio em diferentes demandas atencionais. FISIOTERAPIA E PESQUISA 2016. [DOI: 10.1590/1809-2950/16659423042016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO O objetivo deste estudo foi avaliar o equilíbrio de pacientes com doença de Parkinson (DP) na posição de tandem com os olhos abertos (OA), olhos fechados (OF) e em condição de dupla tarefa (DT). Trata-se de um estudo transversal composto por 19 indivíduos com DP nos estágios leve a moderado. Os pacientes foram avaliados em uma plataforma de força Biomec400. Os parâmetros analisados foram a área do centro de pressão dos pés (COP) e a amplitude e velocidade do COP nas direções anteroposterior (AP) e mediolateral (ML). Foram encontrados resultados estatisticamente significantes para amplitude AP e ML do COP e da área do COP, com valores maiores para as posições em tandem de OF e tandem com DT, quando comparados com a posição em tandem de OA. Os valores de velocidade média AP e ML foram maiores na posição em tandem de OF em comparação ao tandem de OA (p=0,009 e p=0), respectivamente. Concluiu-se que indivíduos com DP, quando submetidos a desafios cognitivos, comportam-se de forma semelhante à retirada do recurso visual no que diz respeito às alterações de equilíbrio. Isso reforça a necessidade de introduzir no plano terapêutico desses indivíduos atividades que requeiram o treino dessas habilidades.
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Barbieri FA, Polastri PF, Baptista AM, Lirani-Silva E, Simieli L, Orcioli-Silva D, Beretta VS, Gobbi LTB. Effects of disease severity and medication state on postural control asymmetry during challenging postural tasks in individuals with Parkinson's disease. Hum Mov Sci 2015; 46:96-103. [PMID: 26741255 DOI: 10.1016/j.humov.2015.12.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 12/01/2015] [Accepted: 12/17/2015] [Indexed: 11/19/2022]
Abstract
The aim of this study was to investigate the effects of disease severity and medication state on postural control asymmetry during challenging tasks in individuals with Parkinson's disease (PD). Nineteen people with PD and 11 neurologically healthy individuals performed three standing task conditions: bipedal standing, tandem and unipedal adapted standing; the individuals with PD performed the tasks in ON and OFF medication state. The participants with PD were distributed into 2 groups according to disease severity: unilateral group (n=8) and bilateral group (n=11). The two PD groups performed the evaluations both under and without the medication. Two force plates were used to analyze the posture. The symmetric index was calculated for various of center of pressure. ANOVA one-way (groups) and two-way (PD groups×medication), with repeated measures for medication, were calculated. For main effects of group, the bilateral group was more asymmetric than CG. For main effects of medication, only unipedal adapted standing presented effects of PD medication. There was PD groups×medication interaction. Under the effects of medication, the unilateral group presented lower asymmetry of RMS in anterior-posterior direction and area than the bilateral group in unipedal adapted standing. In addition, the unilateral group presented lower asymmetry of mean velocity, RMS in anterior-posterior direction and area in unipedal standing and area in tandem adapted standing after a medication dose. Postural control asymmetry during challenging postural tasks was dependent on disease severity and medication state in people with PD. The bilateral group presented higher postural control asymmetry than the control and unilateral groups in challenging postural tasks. Finally, the medication dose was able to reduce postural control asymmetry in the unilateral group during challenging postural tasks.
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Affiliation(s)
- Fabio A Barbieri
- Univ Estadual Paulista - Campus Rio Claro, Posture and Gait Studies Laboratory, Av. 24-A, 1515, Rio Claro, SP CEP: 13506-900, Brazil; Univ Estadual Paulista - Campus Bauru, Laboratory of Human Movement Research, Laboratory of Information, Vision and Action, Av. Eng. Luiz Edmundo Carrijo Coube, 14-01, Bauru, SP CEP: 17033-360, Brazil.
| | - Paula F Polastri
- Univ Estadual Paulista - Campus Bauru, Laboratory of Human Movement Research, Laboratory of Information, Vision and Action, Av. Eng. Luiz Edmundo Carrijo Coube, 14-01, Bauru, SP CEP: 17033-360, Brazil
| | - André M Baptista
- Univ Estadual Paulista - Campus Rio Claro, Posture and Gait Studies Laboratory, Av. 24-A, 1515, Rio Claro, SP CEP: 13506-900, Brazil; Univ Estadual Paulista - Campus Bauru, Laboratory of Human Movement Research, Laboratory of Information, Vision and Action, Av. Eng. Luiz Edmundo Carrijo Coube, 14-01, Bauru, SP CEP: 17033-360, Brazil
| | - Ellen Lirani-Silva
- Univ Estadual Paulista - Campus Rio Claro, Posture and Gait Studies Laboratory, Av. 24-A, 1515, Rio Claro, SP CEP: 13506-900, Brazil
| | - Lucas Simieli
- Univ Estadual Paulista - Campus Rio Claro, Posture and Gait Studies Laboratory, Av. 24-A, 1515, Rio Claro, SP CEP: 13506-900, Brazil
| | - Diego Orcioli-Silva
- Univ Estadual Paulista - Campus Rio Claro, Posture and Gait Studies Laboratory, Av. 24-A, 1515, Rio Claro, SP CEP: 13506-900, Brazil
| | - Victor S Beretta
- Univ Estadual Paulista - Campus Rio Claro, Posture and Gait Studies Laboratory, Av. 24-A, 1515, Rio Claro, SP CEP: 13506-900, Brazil
| | - Lilian T B Gobbi
- Univ Estadual Paulista - Campus Rio Claro, Posture and Gait Studies Laboratory, Av. 24-A, 1515, Rio Claro, SP CEP: 13506-900, Brazil
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