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Martiš P, Košutzká Z, Kranzl A. A Step Forward Understanding Directional Limitations in Markerless Smartphone-Based Gait Analysis: A Pilot Study. SENSORS (BASEL, SWITZERLAND) 2024; 24:3091. [PMID: 38793945 PMCID: PMC11125344 DOI: 10.3390/s24103091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/02/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024]
Abstract
The progress in markerless technologies is providing clinicians with tools to shorten the time of assessment rapidly, but raises questions about the potential trade-off in accuracy compared to traditional marker-based systems. This study evaluated the OpenCap system against a traditional marker-based system-Vicon. Our focus was on its performance in capturing walking both toward and away from two iPhone cameras in the same setting, which allowed capturing the Timed Up and Go (TUG) test. The performance of the OpenCap system was compared to that of a standard marker-based system by comparing spatial-temporal and kinematic parameters in 10 participants. The study focused on identifying potential discrepancies in accuracy and comparing results using correlation analysis. Case examples further explored our results. The OpenCap system demonstrated good accuracy in spatial-temporal parameters but faced challenges in accurately capturing kinematic parameters, especially in the walking direction facing away from the cameras. Notably, the two walking directions observed significant differences in pelvic obliquity, hip abduction, and ankle flexion. Our findings suggest areas for improvement in markerless technologies, highlighting their potential in clinical settings.
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Affiliation(s)
- Pavol Martiš
- 2nd Department of Neurology, Faculty of Medicine, Comenius University, 833 05 Bratislava, Slovakia;
| | - Zuzana Košutzká
- 2nd Department of Neurology, Faculty of Medicine, Comenius University, 833 05 Bratislava, Slovakia;
| | - Andreas Kranzl
- Laboratory for Gait and Movement Analysis, Orthopedic Hospital Speising, 1130 Vienna, Austria
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2
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Zatti C, Pilotto A, Hansen C, Rizzardi A, Catania M, Romijnders R, Purin L, Pasolini MP, Schaeffer E, Galbiati A, Ferini-Strambi L, Berg D, Maetzler W, Padovani A. Turning alterations detected by mobile health technology in idiopathic REM sleep behavior disorder. NPJ Parkinsons Dis 2024; 10:64. [PMID: 38499543 PMCID: PMC10948811 DOI: 10.1038/s41531-024-00682-6] [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: 06/17/2023] [Accepted: 03/12/2024] [Indexed: 03/20/2024] Open
Abstract
Idiopathic REM sleep Behavior Disorder (iRBD) is a condition at high risk of developing Parkinson's disease (PD) and other alpha-synucleinopathies. The aim of the study was to evaluate subtle turning alterations by using Mobile health technology in iRBD individuals without subthreshold parkinsonism. A total of 148 participants (23 persons with polysomnography-confirmed iRBD without subthreshold parkinsonism, 60 drug-naïve PD patients, and 65 age-matched controls were included in this prospective cross-sectional study. All underwent a multidimensional assessment including cognitive and non-motor symptoms assessment. Then a Timed-Up-and-Go test (TUG) at normal and fast speed was performed using mobile health technology on the lower back (Rehagait®, Hasomed, Germany). Duration, mean, and peak angular velocities of the turns were compared using a multivariate model correcting for age and sex. Compared to controls, PD patients showed longer turn durations and lower mean and peak angular velocities of the turns in both TUGs (all p ≤ 0.001). iRBD participants also showed a longer turn duration and lower mean (p = 0.006) and peak angular velocities (p < 0.001) compared to controls, but only in the TUG at normal speed. Mobile health technology assessment identified subtle alterations of turning in subjects with iRBD in usual, but not fast speed. Longitudinal studies are warranted to evaluate the value of objective turning parameters in defining the risk of conversion to PD in iRBD and in tracking motor progression in prodromal PD.
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Affiliation(s)
- Cinzia Zatti
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
- Laboratory of digital Neurology and biosensors, University of Brescia, Brescia, Italy
- Department of continuity of care and frailty, Neurology Unit, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Andrea Pilotto
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy.
- Laboratory of digital Neurology and biosensors, University of Brescia, Brescia, Italy.
- Department of continuity of care and frailty, Neurology Unit, ASST Spedali Civili of Brescia, Brescia, Italy.
| | - Clint Hansen
- Department of Neurology, University Hospital Schleswig-Holstein and Kiel University, Kiel, Germany
| | - Andrea Rizzardi
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
- Laboratory of digital Neurology and biosensors, University of Brescia, Brescia, Italy
| | - Marcello Catania
- Laboratory of digital Neurology and biosensors, University of Brescia, Brescia, Italy
- Department of continuity of care and frailty, Neurology Unit, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Robbin Romijnders
- Department of Neurology, University Hospital Schleswig-Holstein and Kiel University, Kiel, Germany
| | - Leandro Purin
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
- Laboratory of digital Neurology and biosensors, University of Brescia, Brescia, Italy
- Department of continuity of care and frailty, Neurology Unit, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Maria P Pasolini
- Department of Clinical and Experimental Sciences, Neurophysiology Unit, University of Brescia, Brescia, Italy
| | - Eva Schaeffer
- Department of Neurology, University Hospital Schleswig-Holstein and Kiel University, Kiel, Germany
| | - Andrea Galbiati
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology-Sleep Disorders Centre, Milan, Italy
- Faculty of Psychology, "Vita-Salute" San Raffaele University, Milan, Italy
| | - Luigi Ferini-Strambi
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology-Sleep Disorders Centre, Milan, Italy
- Faculty of Psychology, "Vita-Salute" San Raffaele University, Milan, Italy
| | - Daniela Berg
- Department of Neurology, University Hospital Schleswig-Holstein and Kiel University, Kiel, Germany
| | - Walter Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein and Kiel University, Kiel, Germany
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
- Laboratory of digital Neurology and biosensors, University of Brescia, Brescia, Italy
- Department of continuity of care and frailty, Neurology Unit, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, Neurophysiology Unit, University of Brescia, Brescia, Italy
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Robertson-Dick EE, Timm EC, Pal G, Ouyang B, Liu Y, Berry-Kravis E, Hall DA, O’Keefe JA. Digital gait markers to potentially distinguish fragile X-associated tremor/ataxia syndrome, Parkinson's disease, and essential tremor. Front Neurol 2023; 14:1308698. [PMID: 38162443 PMCID: PMC10755476 DOI: 10.3389/fneur.2023.1308698] [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: 10/06/2023] [Accepted: 11/22/2023] [Indexed: 01/03/2024] Open
Abstract
Background Fragile X-associated tremor/ataxia syndrome (FXTAS), a neurodegenerative disease that affects carriers of a 55-200 CGG repeat expansion in the fragile X messenger ribonucleoprotein 1 (FMR1) gene, may be given an incorrect initial diagnosis of Parkinson's disease (PD) or essential tremor (ET) due to overlapping motor symptoms. It is critical to characterize distinct phenotypes in FXTAS compared to PD and ET to improve diagnostic accuracy. Fast as possible (FP) speed and dual-task (DT) paradigms have the potential to distinguish differences in gait performance between the three movement disorders. Therefore, we sought to compare FXTAS, PD, and ET patients using quantitative measures of functional mobility and gait under self-selected (SS) speed, FP, and DT conditions. Methods Participants with FXTAS (n = 22), PD (n = 23), ET (n = 20), and controls (n = 20) underwent gait testing with an inertial sensor system (APDM™). An instrumented Timed Up and Go test (i-TUG) was used to measure movement transitions, and a 2-min walk test (2MWT) was used to measure gait and turn variables under SS, FP, and DT conditions, and dual-task costs (DTC) were calculated. ANOVA and multinomial logistic regression analyses were performed. Results PD participants had reduced stride lengths compared to FXTAS and ET participants under SS and DT conditions, longer turn duration than ET participants during the FP task, and less arm symmetry than ET participants in SS gait. They also had greater DTC for stride length and velocity compared to FXTAS participants. On the i-TUG, PD participants had reduced sit-to-stand peak velocity compared to FXTAS and ET participants. Stride length and arm symmetry index during the DT 2MWT was able to distinguish FXTAS and ET from PD, such that participants with shorter stride lengths were more likely to have a diagnosis of PD and those with greater arm asymmetry were more likely to be diagnosed with PD. No gait or i-TUG parameters distinguished FXTAS from ET participants in the regression model. Conclusion This is the first quantitative study demonstrating distinct gait and functional mobility profiles in FXTAS, PD, and ET which may assist in more accurate and timely diagnosis.
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Affiliation(s)
- Erin E. Robertson-Dick
- Department of Anatomy and Cell Biology, Rush University Medical Center, Chicago, IL, United States
| | - Emily C. Timm
- Department of Anatomy and Cell Biology, Rush University Medical Center, Chicago, IL, United States
| | - Gian Pal
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Bichun Ouyang
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Yuanqing Liu
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Elizabeth Berry-Kravis
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, United States
- Department of Biochemistry, Rush University Medical Center, Chicago, IL, United States
| | - Deborah A. Hall
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Joan A. O’Keefe
- Department of Anatomy and Cell Biology, Rush University Medical Center, Chicago, IL, United States
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
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Griffiths J, Seesen M, Sirikul W, Siviroj P. The Relationship between Handgrip Strength, Timed Up-and-Go, and Mild Cognitive Impairment in Older People during COVID-19 Pandemic Restrictions. Behav Sci (Basel) 2023; 13:bs13050410. [PMID: 37232647 DOI: 10.3390/bs13050410] [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: 03/31/2023] [Revised: 05/01/2023] [Accepted: 05/12/2023] [Indexed: 05/27/2023] Open
Abstract
The COVID-19 lockdown restrictions affected physical performance and cognitive function in older people as they were confined to their homes. There is an association between physical and cognitive functions. Mild Cognitive Impairment (MCI) is a condition that risks progressing to dementia. This study aimed to identify the relationship between handgrip strength (HGS), Timed Up-and-Go (TUG), and MCI in older people during the COVID-19 pandemic restrictions. The cross-sectional study recruited 464 eligible participants for an interview and anthropometric measurement. The Montreal Cognitive Assessment-Basic (MoCA-B), HGS, and TUG were measured in addition to demographic and health characteristics. A total of 398 participants (85.8%) were found to have MCI when screened with the MoCA-B. Their mean age was 71.09 ± 5.81 years. Forward multiple regression analysis demonstrated that HGS (β = 0.032, p < 0.001), education level (β = 2.801, p < 0.001), TUG (β = -0.022, p = 0.013), Thai Geriatric Depression Score, TGDS (β = -0.248, p = 0.011), and age (β = -1.677, p = 0.019) were associated with MCI. A decrease in HGS and an increased TUG might allow for the early detection of MCI and promote physical training in order to reduce the risk of MCI. Further studies can investigate multidomain indicators for MCI, for example, fine motor skills and pinch strength as components of the motor abilities.
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Affiliation(s)
- Jiranan Griffiths
- Department of Occupational Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Mathuramat Seesen
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Wachiranun Sirikul
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Center of Data Analytics and Knowledge Synthesis for Health Care, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Penprapa Siviroj
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
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Ortega-Bastidas P, Gómez B, Aqueveque P, Luarte-Martínez S, Cano-de-la-Cuerda R. Instrumented Timed Up and Go Test (iTUG)-More Than Assessing Time to Predict Falls: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:3426. [PMID: 37050485 PMCID: PMC10098780 DOI: 10.3390/s23073426] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 06/19/2023]
Abstract
The Timed Up and Go (TUG) test is a widely used tool for assessing the risk of falls in older adults. However, to increase the test's predictive value, the instrumented Timed Up and Go (iTUG) test has been developed, incorporating different technological approaches. This systematic review aims to explore the evidence of the technological proposal for the segmentation and analysis of iTUG in elderlies with or without pathologies. A search was conducted in five major databases, following PRISMA guidelines. The review included 40 studies that met the eligibility criteria. The most used technology was inertial sensors (75% of the studies), with healthy elderlies (35%) and elderlies with Parkinson's disease (32.5%) being the most analyzed participants. In total, 97.5% of the studies applied automatic segmentation using rule-based algorithms. The iTUG test offers an economical and accessible alternative to increase the predictive value of TUG, identifying different variables, and can be used in clinical, community, and home settings.
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Affiliation(s)
- Paulina Ortega-Bastidas
- Health Sciences PhD Programme, International Doctoral School, Universidad Rey Juan Carlos, 28922 Madrid, Spain
- Kinesiology Department, Faculty of Medicine, Universidad de Concepción, Concepción, 151 Janequeo St., Concepcion 4030000, Chile
| | - Britam Gómez
- Biomedical Engineering, Faculty of Engineering, Universidad de Santiago de Chile, Libertador Bernardo O’Higgins Av., Santiago 9170022, Chile
| | - Pablo Aqueveque
- Department of Electrical Engineering, Faculty of Engineering, Universidad de Concepción, 219 Edmundo Larenas St., Concepción 4030000, Chile
| | - Soledad Luarte-Martínez
- Kinesiology Department, Faculty of Medicine, Universidad de Concepción, Concepción, 151 Janequeo St., Concepcion 4030000, Chile
| | - Roberto Cano-de-la-Cuerda
- Physiotherapy, Occupational Therapy, Rehabilitation and Physical Medicine Department, Universidad Rey Juan Carlos, 28922 Madrid, Spain
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Spina S, Facciorusso S, D'Ascanio MC, Morone G, Baricich A, Fiore P, Santamato A. Sensor based assessment of turning during instrumented Timed Up and Go Test for quantifying mobility in chronic stroke patients. Eur J Phys Rehabil Med 2023; 59:6-13. [PMID: 36511168 PMCID: PMC10035361 DOI: 10.23736/s1973-9087.22.07647-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Turning may be particularly challenging for stroke patients leading to decreased mobility and increased functional restriction. Timed up and go instrumentation using a simple technology in the clinical context could allow for the collection of both traditional and potentially more discriminatory variables in turning ability. AIM Determine whether the speed turning metrics obtained by a single inertial sensor are suitable for differentiating between stroke patients with varying levels of mobility and disability. DESIGN Cross-sectional study. SETTING Outpatients setting. POPULATION Chronic stroke patients. METHODS A total of 48 chronic stroke patients and 23 healthy controls were included. Stroke patients were divided in two groups based on the total iTUG score: an impaired mobility (> 20 seconds) and an available mobility (<20 seconds) group. All subjects performed an instrumented Timed Up and Go (iTUG) wearing a single IMU sensor on the lower back. Time of subcomponents of the timed up and go test and kinematic parameters of turning were quantified. Other clinical outcomes were: 10 meters walk test, Functional Ambulation Categories Scale (FAC), the Rivermead Mobility Index (RMI), Modified Rankin Scale and the Saltin-Grimby Physical Activity Level Scale (SGPALS). RESULTS There were significant differences (P<0.01) in iTUG phases and turning speeds among groups. Low to strong significant correlations were found between measures derived from the turning speeds and clinical measures. The area under the curve (AUC) of Receiver Operating Characteristic (ROC) turning speeds was demonstrated to be able to discriminate (AUC: 0.742-0.912) from available to impaired stroke patients. CONCLUSIONS This study provides evidence that turning speeds during timed up and go test are accurate measures of mobility and capable of discriminating stroke patients with impaired mobility from those with normal mobility. CLINICAL REHABILITATION IMPACT The turning metrics are related to impairment and mobility in chronic stroke patients; hence they are important to include during clinical evaluation and may assist in creating a customized strategy, assess potential treatments, and effectively organize recovery.
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Affiliation(s)
- Stefania Spina
- Section of Physical Medicine and Rehabilitation, Spasticity and Movement Disorders "ReSTaRt" Unit, Policlinico Riuniti, University of Foggia, Foggia, Italy
| | - Salvatore Facciorusso
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy -
| | - Milena C D'Ascanio
- Section of Physical Medicine and Rehabilitation, Spasticity and Movement Disorders "ReSTaRt" Unit, Policlinico Riuniti, University of Foggia, Foggia, Italy
| | - Giovanni Morone
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
- San Raffaele Institute of Sulmona, Sulmona, L'Aquila, Italy
| | - Alessio Baricich
- Physical Medicine and Rehabilitation Unit, University Hospital "Maggiore della Carità", Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy
| | - Pietro Fiore
- Neurorehabilitation Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Institute of Bari, Bari, Italy
| | - Andrea Santamato
- Section of Physical Medicine and Rehabilitation, Spasticity and Movement Disorders "ReSTaRt" Unit, Policlinico Riuniti, University of Foggia, Foggia, Italy
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Zhu S, Wu Z, Wang Y, Jiang Y, Gu R, Zhong M, Jiang X, Shen B, Zhu J, Yan J, Pan Y, Zhang L. Gait Analysis with Wearables Is a Potential Progression Marker in Parkinson's Disease. Brain Sci 2022; 12:1213. [PMID: 36138949 PMCID: PMC9497215 DOI: 10.3390/brainsci12091213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/17/2022] [Accepted: 09/05/2022] [Indexed: 11/17/2022] Open
Abstract
Gait disturbance is a prototypical feature of Parkinson's disease (PD), and the quantification of gait using wearable sensors is promising. This study aimed to identify gait impairment in the early and progressive stages of PD according to the Hoehn and Yahr (H-Y) scale. A total of 138 PD patients and 56 healthy controls (HCs) were included in our research. We collected gait parameters using the JiBuEn gait-analysis system. For spatiotemporal gait parameters and kinematic gait parameters, we observed significant differences in stride length (SL), gait velocity, the variability of SL, heel strike angle, and the range of motion (ROM) of the ankle, knee, and hip joints between HCs and PD patients in H-Y Ⅰ-Ⅱ. The changes worsened with the progression of PD. The differences in the asymmetry index of the SL and ROM of the hip were found between HCs and patients in H-Y Ⅳ. Additionally, these gait parameters were significantly associated with Unified Parkinson's Disease Rating Scale and Parkinson's Disease Questionnaire-39. This study demonstrated that gait impairment occurs in the early stage of PD and deteriorates with the progression of the disease. The gait parameters mentioned above may help to detect PD earlier and assess the progression of PD.
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Affiliation(s)
- Sha Zhu
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zhuang Wu
- Neurotoxin Research Center of Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Neurological Department of Tongji Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Yaxi Wang
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yinyin Jiang
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Ruxin Gu
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Min Zhong
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Xu Jiang
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Bo Shen
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Jun Zhu
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Jun Yan
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yang Pan
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Li Zhang
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
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Daniels RJ, Knight CA. Rates of neuromuscular excitation during cycling in Parkinson's disease compared to healthy young and older adults. Clin Biomech (Bristol, Avon) 2021; 90:105488. [PMID: 34571487 DOI: 10.1016/j.clinbiomech.2021.105488] [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: 05/03/2021] [Revised: 09/08/2021] [Accepted: 09/14/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Bradykinesia affects mobility in some people with Parkinson's. Fall risk makes the neural control of maximal speed ambulatory movements difficult to study in Parkinson's. Stationary recumbent bicycling favors the use of electromyography at high movement speeds, and may better reveal neuromuscular rate limiters. METHODS Subjects were 18 adults with Parkinson's, 14 older adults and 14 young adults. Electromyograms were recorded from two muscles during stationary recumbent bicycling at 60, 80, 100, 120 RPM and peak voluntary cadence. Rate of electromyogram rise was calculated. Subjects performed the timed up and go and four square step test. Parkinson's sub-groups were formed based on whether they could pedal ≥120 RPM. Mixed models were used to compare groups and spearman's correlations quantified relationships. FINDINGS Eight people with Parkinson's and four older adults could not complete the 120 RPM condition. Faster people with Parkinson's (n = 10) had greater maximum cadence (F = 42.85, P < 0.05), higher rates of electromyogram rise in both muscles (F > 16.9, P < 0.05), and faster mobility test times (F > 6.5, P < 0.05) than slower people with Parkinson's (n = 8). In Parkinson's, correlations between vastus lateralis rate of electromyogram rise and four square step test (ρ = -0.62), timed up and go (ρ = -0.53), and peak cadence (ρ = 0.76) were significant (all P < 0.05). INTERPRETATION People with Parkinson's with slower peak pedaling cadence had slower mobility performance and lower vastus lateralis excitation rates at higher cadences. Vastus lateralis excitation rates had moderate to strong relationships with peak cadence and mobility. Exercise interventions may seek to improve peak cadence or excitation rates in people with Parkinson's.
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Rizzo R, Knight SP, Davis JRC, Newman L, Duggan E, Kenny RA, Romero-Ortuno R. SART and Individual Trial Mistake Thresholds: Predictive Model for Mobility Decline. Geriatrics (Basel) 2021; 6:geriatrics6030085. [PMID: 34562986 PMCID: PMC8482118 DOI: 10.3390/geriatrics6030085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 11/16/2022] Open
Abstract
The Sustained Attention to Response Task (SART) has been used to measure neurocognitive functions in older adults. However, simplified average features of this complex dataset may result in loss of primary information and fail to express associations between test performance and clinically meaningful outcomes. Here, we describe a new method to visualise individual trial (raw) information obtained from the SART test, vis-à-vis age, and groups based on mobility status in a large population-based study of ageing in Ireland. A thresholding method, based on the individual trial number of mistakes, was employed to better visualise poorer SART performances, and was statistically validated with binary logistic regression models to predict mobility and cognitive decline after 4 years. Raw SART data were available for 4864 participants aged 50 years and over at baseline. The novel visualisation-derived feature bad performance, indicating the number of SART trials with at least 4 mistakes, was the most significant predictor of mobility decline expressed by the transition from Timed Up-and-Go (TUG) < 12 to TUG ≥ 12 s (OR = 1.29; 95% CI 1.14–1.46; p < 0.001), and the only significant predictor of new falls (OR = 1.11; 95% CI 1.03–1.21; p = 0.011), in models adjusted for multiple covariates. However, no SART-related variables resulted significant for the risk of cognitive decline, expressed by a decrease of ≥2 points in the Mini-Mental State Examination (MMSE) score. This novel multimodal visualisation could help clinicians easily develop clinical hypotheses. A threshold approach to the evaluation of SART performance in older adults may better identify subjects at higher risk of future mobility decline.
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Affiliation(s)
- Rossella Rizzo
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, D02 R590 Dublin, Ireland; (S.P.K.); (J.R.C.D.); (L.N.); (E.D.); (R.A.K.); (R.R.-O.)
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
- Correspondence:
| | - Silvin Paul Knight
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, D02 R590 Dublin, Ireland; (S.P.K.); (J.R.C.D.); (L.N.); (E.D.); (R.A.K.); (R.R.-O.)
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - James R. C. Davis
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, D02 R590 Dublin, Ireland; (S.P.K.); (J.R.C.D.); (L.N.); (E.D.); (R.A.K.); (R.R.-O.)
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Louise Newman
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, D02 R590 Dublin, Ireland; (S.P.K.); (J.R.C.D.); (L.N.); (E.D.); (R.A.K.); (R.R.-O.)
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Eoin Duggan
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, D02 R590 Dublin, Ireland; (S.P.K.); (J.R.C.D.); (L.N.); (E.D.); (R.A.K.); (R.R.-O.)
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, D02 R590 Dublin, Ireland; (S.P.K.); (J.R.C.D.); (L.N.); (E.D.); (R.A.K.); (R.R.-O.)
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
- Mercer’s Institute for Successful Ageing, St. James’s Hospital, D08 NHY1 Dublin, Ireland
| | - Roman Romero-Ortuno
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, D02 R590 Dublin, Ireland; (S.P.K.); (J.R.C.D.); (L.N.); (E.D.); (R.A.K.); (R.R.-O.)
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
- Mercer’s Institute for Successful Ageing, St. James’s Hospital, D08 NHY1 Dublin, Ireland
- Global Brain Health Institute, Trinity College Dublin, D02 PN40 Dublin, Ireland
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Costa-Ribeiro A, Andrade SMMDS, Férrer MLV, Silva OAPD, Salvador MLS, Smaili S, Lindquist ARR. Can Task Specificity Impact tDCS-Linked to Dual Task Training Gains in Parkinson's Disease? A Protocol for a Randomized Controlled Trial. Front Aging Neurosci 2021; 13:684689. [PMID: 34276344 PMCID: PMC8281034 DOI: 10.3389/fnagi.2021.684689] [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: 03/23/2021] [Accepted: 06/07/2021] [Indexed: 11/13/2022] Open
Abstract
Patients with Parkinson's disease (PD) have difficulties while performing dual-task activities, a condition present in everyday life. It is possible that strategies such as transcranial Direct Current Stimulation (tDCS) can be associated with motor training enriched with dual-task training to improve the performance of two concurrent tasks. Currently, it is unclear whether specific tasks and clinical conditions of PD patients have different results after the intervention. Therefore, the proposed randomized controlled trial will examine task-dependency in enhancing the effects of tDCS-linked rehabilitation training on PD and the relationships between baseline outcomes in responders and non-responders to therapy. Fifty-six patients with Parkinson's disease will be recruited to participate in this controlled, double-blind randomized multicentric clinical trial. Patients in modified Hoehn & Yahr stage 1.5-3, age between 40 and 70 years will be included. Subjects will be randomly assigned to an experimental group (EG) and a control group (CG). The EG will perform treadmill gait training associated with dual task exercises+tDCS, while the CG will only engage in treadmill gait training+tDCS. Blinded testers will assess patients before and after 12 intervention sessions and after a 4-week follow-up period. All patients will undergo a screening and an initial visit before being assessed for primary and secondary outcomes. The primary outcome measure is functional mobility measured by Timed Up and Go Test. Secondary outcomes include cognitive function, participation, motor function and body function and structure. This study will evaluate the effectiveness of an intervention protocol with tDCS, dual-task training and gait training in patients with PD. The study will also highlight the clinical factors and variability between individuals that could interfere in the training of a specific task and influence the therapeutic effect. Clinical Trial registration: www.ClinicalTrials.gov, identifier NCT04581590.
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Affiliation(s)
- Adriana Costa-Ribeiro
- NeuroMove Laboratory, Department of Physiotherapy, Federal University of Paraíba, Campus I Cidade Universitária, Joao Pessoa, Brazil
| | | | - Mayane Laís Veloso Férrer
- NeuroMove Laboratory, Department of Physiotherapy, Federal University of Paraíba, Campus I Cidade Universitária, Joao Pessoa, Brazil
| | - Ozair Argentille Pereira Da Silva
- Laboratory of Intervention and Analysis of Movement, Department of Physiotherapy, Federal University of Rio Grande do Norte, Campus Universitário, Natal, Brazil
| | - Maiara Llarena Silva Salvador
- Neuroscience and Aging Laboratory, Federal University of Paraíba, Campus I Cidade Universitária, Joao Pessoa, Brazil
| | - Suhaila Smaili
- Department of Physiotherapy, State University of Londrina, Londrina, Brazil
| | - Ana Raquel Rodrigues Lindquist
- Laboratory of Intervention and Analysis of Movement, Department of Physiotherapy, Federal University of Rio Grande do Norte, Campus Universitário, Natal, Brazil
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11
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Chintapalli R, Romero-Ortuno R. Choice reaction time and subsequent mobility decline: Prospective observational findings from The Irish Longitudinal Study on Ageing (TILDA). EClinicalMedicine 2021; 31:100676. [PMID: 33554081 PMCID: PMC7846709 DOI: 10.1016/j.eclinm.2020.100676] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/15/2020] [Accepted: 11/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cognitive and motor function in ageing are intertwined, but whether slower motor response time (MRT) to a cognitive stimulus could herald accelerated mobility decline is unknown. Using data from The Irish Longitudinal Study on Ageing (TILDA), we examined whether slower MRT may predict a greater than expected increase in Time Up and Go (TUG) after 4 years. METHODS Participants aged 50 years or older were divided into two groups based on their mean MRT (< 250 ms versus ≥ 250 ms). A repeated measures ANOVA compared TUG trajectories between groups, controlling for baseline age, sex, height, education level, mini mental-state examination (MMSE) score, self-reported vision and hearing, medical conditions (cardiovascular, cerebrovascular disease, diabetes), and number of medications. FINDINGS At Wave 1, 1982 (58.7%) had a mean MRT of < 250 ms, with a mean TUG of 8.1 s (SD 1.6); and 1397 (41.3%) had an MRT of ≥ 250 ms, with a TUG of 9.0 s (SD 2.2). At Wave 3, TUG increased to 8.8 s (SD 2.0) and 10.2 s (SD 3.9), respectively. The results of the adjusted repeated measures ANOVA suggested that there was a statistically significant interaction between MRT group and Wave (P = 0.023, η2 p = 0.002). INTERPRETATION TILDA participants in the slower MRT group seemed to have faster mobility decline, but this effect was statistically and clinically small. FUNDING TILDA is funded by Atlantic Philanthropies, the Irish Department of Health and Irish Life. Roman Romero-Ortuno is funded by Science Foundation Ireland (grant number 18/FRL/6188).
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Affiliation(s)
- Renuka Chintapalli
- Department of Physiology, Development and Neuroscience, University of Cambridge, United Kingdom
- Corresponding author.
| | - Roman Romero-Ortuno
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Ireland
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Ireland
- Global Brain Health Institute, Trinity College Dublin, Ireland
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12
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Rodríguez MÁ, Albillos-Almaraz L, López-Aguado I, Crespo I, Del Valle M, Olmedillas H. Vigorous Aerobic Exercise in the Management of Parkinson Disease: A Systematic Review. PM R 2020; 13:890-900. [PMID: 32978867 DOI: 10.1002/pmrj.12500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 09/02/2020] [Accepted: 09/09/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To summarize the findings from studies examining the effects of vigorous-intensity aerobic exercise in the management of Parkinson disease. TYPE: Systematic review. LITERATURE SURVEY PubMed/MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Library, SPORTDiscus, and ScienceDirect databases were searched up to May 2020. Reference lists of the included articles were also searched for additional studies. Searches were restricted to English language. METHODOLOGY Seven papers, including six studies, five randomized controlled trials and one controlled trial, were identified. The studies examined the effects of vigorous-intensity aerobic exercise in participants with Parkinson disease. Studies in which the minimal intensity required was ≥77% of maximum heart rate, 60% of heart rate reserve or 64% of maximal oxygen uptake met the inclusion criteria. Method appraisal showed a mean score of 5.3 in the Physiotherapy Evidence Database (PEDro) scale. SYNTHESIS No statistically significant differences were found between vigorous-intensity aerobic exercise and moderate/low-intensity aerobic exercise for the main outcomes (disease severity and motor function). Only one study concluded a significant higher aerobic fitness in favor of the group that exercised at vigorous intensity compared to the moderate intensity group. CONCLUSIONS Vigorous-intensity aerobic exercise has not shown statistically significant improvements in motor and nonmotor impairments in individuals with Parkinson disease as compared to moderate/low-intensity aerobic exercise. Hence, the current evidence is too limited to allow recommendations for clinical practice.
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Affiliation(s)
| | | | | | - Irene Crespo
- Department of Functional Biology, Universidad de Oviedo, Oviedo, Spain.,Institute of Biomedicine, Universidad de León, León, Spain
| | - Miguel Del Valle
- Department of Cellular Morphology and Biology, Universidad de Oviedo, Oviedo, Spain
| | - Hugo Olmedillas
- Department of Functional Biology, Universidad de Oviedo, Oviedo, Spain.,Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
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13
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Statistical analysis of the 180 degree walking turn: Common patterns, repeatability and prediction bands of turn signals. Biomed Signal Process Control 2020. [DOI: 10.1016/j.bspc.2019.101689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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14
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Viteckova S, Krupicka R, Cejka V, Kutilek P, Szabo Z, Růžička E, Dusek P. Waveform skewness: Parameter for timed Up & Go turn assessment. Biomed Signal Process Control 2019. [DOI: 10.1016/j.bspc.2019.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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15
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Hobert MA, Nussbaum S, Heger T, Berg D, Maetzler W, Heinzel S. Progressive Gait Deficits in Parkinson's Disease: A Wearable-Based Biannual 5-Year Prospective Study. Front Aging Neurosci 2019; 11:22. [PMID: 30814947 PMCID: PMC6381067 DOI: 10.3389/fnagi.2019.00022] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/28/2019] [Indexed: 12/20/2022] Open
Abstract
Background: Gait changes occur during all Parkinson’s disease (PD) stages and wearable sensor-derived gait parameters may quantify PD progression. However, key aspects that may qualify quantitative gait parameters as progression markers in PD remain elusive. Objectives: Longitudinal changes in gait parameters from a lower-back sensor under convenient and challenging walking conditions in early- and mid-stage PD patients (E-PD, M-PD) compared to controls were investigated. Methods: Normal- and fast-pace parameters (step: number, time, velocity, variability) were assessed every 6 months for up to 5 years in 22 E-PD (<4 years baseline disease duration), 18 M-PD (>5 years) and 24 controls. Parameter trajectories and associations with MDS-UPDRS-III were tested using generalized estimating equations. Results: Normal-pace step number (annual change in E-PD: 2.1%, Time∗Group: p = 0.001) and step time variability (8.5%, p < 0.05) longitudinally increased in E-PD compared to controls (0.7%, -12%). For fast pace, no significant progression differences between groups were observed. Longitudinal changes in M-PD did not differ significantly from controls. MDS-UPDRS-III was largely associated with normal-pace parameters in M-PD. Conclusion: Wearables can quantify progressive gait deficits indicated by increasing step number and step time variability in E-PD. In M-PD, and for fast-pace, gait parameters possess limited potential as PD progression markers.
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Affiliation(s)
- Markus A Hobert
- Department of Neurology, Christian-Albrechts-University zu Kiel, Kiel, Germany.,Department of Neurodegenerative, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Susanne Nussbaum
- Department of Neurodegenerative, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Tanja Heger
- Department of Neurodegenerative, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Daniela Berg
- Department of Neurology, Christian-Albrechts-University zu Kiel, Kiel, Germany.,Department of Neurodegenerative, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Walter Maetzler
- Department of Neurology, Christian-Albrechts-University zu Kiel, Kiel, Germany.,Department of Neurodegenerative, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Sebastian Heinzel
- Department of Neurology, Christian-Albrechts-University zu Kiel, Kiel, Germany
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16
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The transition between turning and sitting in patients with Parkinson's disease: A wearable device detects an unexpected sequence of events. Gait Posture 2019; 67:224-229. [PMID: 30380506 PMCID: PMC6287952 DOI: 10.1016/j.gaitpost.2018.10.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/27/2018] [Accepted: 10/14/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND When older adults turn to sit, about 80% of the subjects complete the turn before starting to sit i.e., a distinct-strategy, while in about 20%, part of the turning and sitting take place concurrently, i.e., an overlapping-strategy. A prolonged duration of the separation between tasks in the distinct-strategy (D-interval) and a prolonged duration of the overlap interval in overlapping-strategy (O-interval) are related to worse motor symptoms and poorer cognition. In the present study, we evaluated what strategy is employed by patients with Parkinson's disease (PD) when they transition from turning to sitting. METHODS 96 participants with PD performed turn to sit as part of the Timed Up and Go test, both with and without medications, while wearing a body-fixed sensor. We quantified the turn-to-sit transition and determined which strategy (distinct or overlapping) was employed. We then stratified the cases and used regression models adjusted for age, gender, height, and weight to examine the associations of the D-interval or O-interval with parkinsonian features and cognition. RESULTS Most patients (66%) employed the overlapping-strategy, both off and on anti-parkinsonian medications. Longer O-intervals were associated with longer duration of PD, more severe PD motor symptoms, a higher postural-instability-gait-disturbance (PIGD) score, and worse freezing of gait. Longer D-intervals were not associated with disease duration or PD motor symptoms. Neither the D- nor O-intervals were related to cognitive function. Individuals who employed the overlapping-strategy had more severe postural instability (i.e., higher PIGD scores), as compared to those who used the distinct-strategy. SIGNIFICANCE In contrast to older adults without PD, most patients with PD utilize the overlapping strategy. Poorer postural and gait control are associated with the strategy choice and with the duration of concurrent performance of turning and sitting. Additional work is needed to further explicate the mechanisms underlying these strategies and their clinical implications.
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Merchán-Baeza JA, González-Sánchez M, Cuesta-Vargas AI. Using Smartphones to Collect Quantitative Data on Lower Limb Functionality in People Who Have Suffered a Stroke. J Stroke Cerebrovasc Dis 2018; 27:3555-3562. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.08.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 08/08/2018] [Indexed: 01/23/2023] Open
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18
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Williams JM, Nyman SR. Association between the instrumented timed up and go test and cognitive function, fear of falling and quality of life in community dwelling people with dementia. J Frailty Sarcopenia Falls 2018; 3:185-193. [PMID: 32300707 PMCID: PMC7155353 DOI: 10.22540/jfsf-03-185] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To explore relationships between the instrumented timed up and go test (iTUG) and the following risk factors for falls: cognitive functioning, fear of falling (FoF), and quality of life (QoL) in people with dementia. METHODS 83 community-dwelling older adults with dementia (mean±sd age 78.00±7.96 years; 60.2% male) completed an interview to capture global cognition (Mini-Addenbrooke's Cognitive Evaluation), FoF (Iconographical Falls Efficacy Scale) and QoL (ICEpopCAPability measure for Older people). Participants completed an iTUG whilst wearing an inertial sensor on their trunk. Linear accelerations and rotational velocities demarcated sub-phases of the iTUG. Relationships were explored through correlations and regression modelling. RESULTS Cognition was related to duration of walking sub-phases and total time to complete iTUG (r=0.25-0.28) suggesting gait speed was related to cognition. FoF was most strongly related to turning velocity (r=0.39-0.44), but also to sit-to-stand, gait sub-phases and total time to complete iTUG. Sub-phases explained 27% of the variance in FoF. There were no correlations between iTUG and QoL. CONCLUSIONS Cognition and FoF were related to time to complete walking sub-phases but FoF was more closely related to turning velocity and standing acceleration. iTUG may offer unique insights into motor behaviour in people with dementia.
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Affiliation(s)
- Jonathan M. Williams
- Department of Human Sciences and Public Health, Faculty of Health and Social Sciences, Bournemouth University, UK
| | - Samuel R. Nyman
- Department of Psychology and Ageing & Dementia Research Centre, Faculty of Science and Technology, Bournemouth University, UK
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19
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Bernhard FP, Sartor J, Bettecken K, Hobert MA, Arnold C, Weber YG, Poli S, Margraf NG, Schlenstedt C, Hansen C, Maetzler W. Wearables for gait and balance assessment in the neurological ward - study design and first results of a prospective cross-sectional feasibility study with 384 inpatients. BMC Neurol 2018; 18:114. [PMID: 30115021 PMCID: PMC6094895 DOI: 10.1186/s12883-018-1111-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 07/26/2018] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Deficits in gait and balance are common among neurological inpatients. Currently, assessment of these patients is mainly subjective. New assessment options using wearables may provide complementary and more objective information. METHODS In this prospective cross-sectional feasibility study performed over a four-month period, all patients referred to a normal neurology ward of a university hospital and aged between 40 and 89 years were asked to participate. Gait and balance deficits were assessed with wearables at the ankles and the lower back. Frailty, sarcopenia, Parkinsonism, depression, quality of life, fall history, fear of falling, physical activity, and cognition were evaluated with questionnaires and surveys. RESULTS Eighty-two percent (n = 384) of all eligible patients participated. Of those, 39% (n = 151) had no gait and balance deficit, 21% (n = 79) had gait deficits, 11% (n = 44) had balance deficits and 29% (n = 110) had gait and balance deficits. Parkinson's disease, stroke, epilepsy, pain syndromes, and multiple sclerosis were the most common diseases. The assessment was well accepted. CONCLUSIONS Our study suggests that the use of wearables for the assessment of gait and balance features in a clinical setting is feasible. Moreover, preliminary results confirm previous epidemiological data about gait and balance deficits among neurological inpatients. Evaluation of neurological inpatients with novel wearable technology opens new opportunities for the assessment of predictive, progression and treatment response markers.
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Affiliation(s)
- Felix P. Bernhard
- Department of Neurology and Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University Tübingen, 72076 Tübingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Jennifer Sartor
- Department of Neurology and Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University Tübingen, 72076 Tübingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Kristina Bettecken
- Department of Neurology and Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University Tübingen, 72076 Tübingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Markus A. Hobert
- Department of Neurology and Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University Tübingen, 72076 Tübingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 41, 24105 Kiel, Germany
| | - Carina Arnold
- Department of Neurology and Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University Tübingen, 72076 Tübingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Yvonne G. Weber
- Department of Neurology and Epileptology, University Tübingen, 72076 Tübingen, Germany
| | - Sven Poli
- Department of Neurology & Stroke, University Hospital Tübingen, Tübingen, Germany
| | - Nils G. Margraf
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 41, 24105 Kiel, Germany
| | - Christian Schlenstedt
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 41, 24105 Kiel, Germany
| | - Clint Hansen
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 41, 24105 Kiel, Germany
| | - Walter Maetzler
- Department of Neurology and Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University Tübingen, 72076 Tübingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 41, 24105 Kiel, Germany
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20
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da Silva FC, Iop RDR, de Oliveira LC, Boll AM, de Alvarenga JGS, Gutierres Filho PJB, de Melo LMAB, Xavier AJ, da Silva R. Effects of physical exercise programs on cognitive function in Parkinson's disease patients: A systematic review of randomized controlled trials of the last 10 years. PLoS One 2018; 13:e0193113. [PMID: 29486000 PMCID: PMC5828448 DOI: 10.1371/journal.pone.0193113] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 02/05/2018] [Indexed: 11/18/2022] Open
Abstract
Background Given the relative importance of cognitive impairment, there was considerable interest in identifying the cognitive profile of PD patients, in order to ensure specific and appropriate therapeutic interventions. Purpose To determine the effects of physical exercise programs on cognitive function in PD patients, compared with the control group. Data sources Medline, Cochrane, Scopus, PEDro and Web of Science (last searched in September 2016). Study selection Randomized clinical trials examining the effects of physical exercise programs and cognitive function in PD patients. Nine studies fulfilled the selection criteria and were included in this review. Data extraction Characteristics of the publication, characteristics of the participants, test used for cognitive screening, cognitive domain assessed, tools used to assess cognitive function, characteristics of the experimental intervention, characteristics of the control group, mean results and standard deviation of function cognitive. The PEDro score was used to evaluate methodological quality. Data synthesis Most eligible studies showed good methodological quality based on the PEDro scale. Studies have shown that adapted tango for PD patients, cognitive training combined with motor training, and treadmill training promote the preservation or improvement of cognitive function in PD patients. Limitations The diversity of cognitive tests used to assess cognitive function and the high heterogeneity identified between the physical exercise programs. Conclusions Physical exercise programs promote positive and significant effects on global cognitive function, processing speed, sustained attention and mental flexibility in PD patients, at a mild to moderate stage for patients with a 6-year clinical diagnosis of PD. However, treadmill training performed 3 times a week for about 60 minutes and for a period of 24 weeks produced larger improvements in cognition.
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Affiliation(s)
- Franciele Cascaes da Silva
- University of State of Santa Catarina, Center for Health Sciences and Sports, Adapted Physical Activity Laboratory, Florianópolis, Santa Catarina, Brazil
- * E-mail:
| | - Rodrigo da Rosa Iop
- University of State of Santa Catarina, Center for Health Sciences and Sports, Adapted Physical Activity Laboratory, Florianópolis, Santa Catarina, Brazil
| | - Laiana Cândido de Oliveira
- University of State of Santa Catarina, Center for Health Sciences and Sports, Adapted Physical Activity Laboratory, Florianópolis, Santa Catarina, Brazil
| | - Alice Mathea Boll
- University of State of Santa Catarina, Center for Health Sciences and Sports, Adapted Physical Activity Laboratory, Florianópolis, Santa Catarina, Brazil
| | | | | | | | - André Junqueira Xavier
- University of Southern Santa Catarina, Medicine Course, Florianópolis, Santa Catarina, Brazil
| | - Rudney da Silva
- University of State of Santa Catarina, Center for Health Sciences and Sports, Adapted Physical Activity Laboratory, Florianópolis, Santa Catarina, Brazil
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Bouça-Machado R, Maetzler W, Ferreira JJ. What is Functional Mobility Applied to Parkinson's Disease? JOURNAL OF PARKINSON'S DISEASE 2018; 8:121-130. [PMID: 29480225 PMCID: PMC5836402 DOI: 10.3233/jpd-171233] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/01/2017] [Indexed: 12/17/2022]
Abstract
Although yet poorly defined and often misused, the concept of functional mobility has been used in research studies as a more global and ecological outcome of patients' health status. Functional mobility is a person's physiological ability to move independently and safely in a variety of environments in order to accomplish functional activities or tasks and to participate in the activities of daily living, at home, work and in the community. Parkinson's disease (PD) has a direct impact on patients' motor control and on mobility in general. Even with optimal medical management, the progression of PD is associated with mounting impairments at different levels of body function, causing marked limitations in a wide variety of activities, as well as a severe disability and loss of autonomy. Despite this, for everyday functioning PD patients need to have a good functional mobility that allow them to get around effortlessly in a reasonable amount of time to access to the same environments as others. This paper reviewed the concept of functional mobility applied to PD. This was done through an International Classification of Functioning and Disability (ICF) perspective. Recommendations to address the known factors that contribute to a poor functional mobility were outlined while suggestions for clinical practice and research were made.
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Affiliation(s)
- Raquel Bouça-Machado
- Instituto de Medicina Molecular, Lisbon, Portugal
- CNS-Campus Neurológico Sénior, Torres Vedras, Portugal
| | - Walter Maetzler
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Joaquim J. Ferreira
- Instituto de Medicina Molecular, Lisbon, Portugal
- CNS-Campus Neurológico Sénior, Torres Vedras, Portugal
- Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Portugal
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Ibrahim A, Singh DKA, Shahar S. 'Timed Up and Go' test: Age, gender and cognitive impairment stratified normative values of older adults. PLoS One 2017; 12:e0185641. [PMID: 28972994 PMCID: PMC5626462 DOI: 10.1371/journal.pone.0185641] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 09/15/2017] [Indexed: 11/18/2022] Open
Abstract
Aims The aim of this study was to establish ‘Timed up and Go’ test (TUG) normative data among community dwelling older adults stratified based on cognitive status, gender and age groups. Methods A total of 2084 community dwelling older adults from wave I and II were recruited through a multistage random sampling method. TUG was performed using the standard protocol and scores were then stratified based on with and without mild cognitive impairment (MCI), gender and in a 5-year age groups ranging from ages of 60’s to 80’s. Results 529(16%) participants were identified to have MCI. Past history of falls and medical history of hypertension, heart disease, joint pain, hearing and vision problem, and urinary incontinence were found to have influenced TUG performance. Cognitive status as a mediator, predicted TUG performance even when both gender and age were controlled for (B 0.24, 95% CI (0.02–0.47), β 0.03, t 2.10, p = 0.36). Further descriptive analysis showed, participants with MCI, women and older in age took a longer time to complete TUG, as compared to men with MCI across all age groups with exceptions for some age groups. Conclusion These results suggested that MCI needs to be taken into consideration when testing older adults using TUG, besides age and gender factors. Data using fast speed TUG may be required among older adults with and without MCI for further understanding.
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Affiliation(s)
- Azianah Ibrahim
- Physiotherapy Programme, School of Rehabilitation Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
- Pantai Integrated Rehab Services Sdn Bhd, Pandan Indah, Kuala Lumpur, Malaysia
| | - Devinder Kaur Ajit Singh
- Physiotherapy Programme, School of Rehabilitation Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
- * E-mail:
| | - Suzana Shahar
- Community Rehabilitation and Aging Research Centre, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
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Nishiguchi S, Yorozu A, Adachi D, Takahashi M, Aoyama T. Association between mild cognitive impairment and trajectory-based spatial parameters during timed up and go test using a laser range sensor. J Neuroeng Rehabil 2017; 14:78. [PMID: 28789676 PMCID: PMC5549311 DOI: 10.1186/s12984-017-0289-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 08/01/2017] [Indexed: 11/16/2022] Open
Abstract
Background The Timed Up and Go (TUG) test may be a useful tool to detect not only mobility impairment but also possible cognitive impairment. In this cross-sectional study, we used the TUG test to investigate the associations between trajectory-based spatial parameters measured by laser range sensor (LRS) and cognitive impairment in community-dwelling older adults. Methods The participants were 63 community-dwelling older adults (mean age, 73.0 ± 6.3 years). The trajectory-based spatial parameters during the TUG test were measured using an LRS. In each forward and backward phase, we calculated the minimum distance from the marker, the maximum distance from the x-axis (center line), the length of the trajectories, and the area of region surrounded by the trajectory of the center of gravity and the x-axis (center line). We measured mild cognitive impairment using the Mini-Mental State Examination score (26/27 was the cut-off score for defining mild cognitive impairment). Results Compared with participants with normal cognitive function, those with mild cognitive impairment exhibited the following trajectory-based spatial parameters: short minimum distance from the marker (p = 0.044), narrow area of center of gravity in the forward phase (p = 0.012), and a large forward/whole phase ratio of the area of the center of gravity (p = 0.026) during the TUG test. In multivariate logistic regression analyses, a short minimum distance from the marker (odds ratio [OR]: 0.82, 95% confidence interval [CI]: 0.69–0.98), narrow area of the center of gravity in the forward phase (OR: 0.01, 95% CI: 0.00–0.36), and large forward/whole phase ratio of the area of the center of gravity (OR: 0.94, 95% CI: 0.88–0.99) were independently associated with mild cognitive impairment. Conclusions In conclusion, our results indicate that some of the trajectory-based spatial parameters measured by LRS during the TUG test were independently associated with cognitive impairment in older adults. In particular, older adults with cognitive impairment exhibit shorter minimum distances from the marker and asymmetrical trajectories during the TUG test.
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Affiliation(s)
- Shu Nishiguchi
- Department of Physical Therapy, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
| | - Ayanori Yorozu
- Graduate School of Science and Technology, Keio University, Yokohama, Japan
| | - Daiki Adachi
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masaki Takahashi
- Department of System Design Engineering, Faculty of Science and Technology, Keio University, 3-14-1 Hiyoshi, Kohoku-ku Yokohama, 223-8522, Japan.
| | - Tomoki Aoyama
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Delbroek T, Vermeylen W, Spildooren J. The effect of cognitive-motor dual task training with the biorescue force platform on cognition, balance and dual task performance in institutionalized older adults: a randomized controlled trial. J Phys Ther Sci 2017; 29:1137-1143. [PMID: 28744033 PMCID: PMC5509577 DOI: 10.1589/jpts.29.1137] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 04/12/2017] [Indexed: 11/25/2022] Open
Abstract
[Purpose] This study investigates whether cognition, balance and dual task performance in
institutionalized older adults improves by a virtual reality dual task training. [Subjects
and Methods] Randomized controlled trial; Twenty institutionalized older adults with mild
cognitive impairment (13 female, 7 male; average age, 87.2 ± 5.96 years) were randomized
to the intervention (i.e. Virtual reality dual-task training using the BioRescue) or
control group (no additional training). The intervention group took part in a 6-week
training program while the elderly in the control group maintained their daily activities.
Balance was measured with the Instrumented Timed Up-and-Go Test with and without a
cognitive task. The Observed Emotion Rating Scale and Intrinsic Motivation Inventory were
administered to evaluate the emotions and motivation regarding the exergaming program.
[Results] The intervention group improved significantly on the total Timed Up-and-Go
duration and the turn-to-sit duration during single-task walking in comparison to the
control group who received no additional training. Participants found the virtual reality
dual task training pleasant and useful for their concentration, memory and balance.
Pleasure and alertness were the two emotions which were mostly seen during the
intervention. [Conclusion] The BioRescue is a pleasant and interesting treatment method,
well suited for institutionalized older adults in need of lifelong physical therapy.
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Affiliation(s)
- Tom Delbroek
- Rehabilitaion Research Center (REVAL), Biomedical Research Institute (BIOMED), Faculty of Medicine and Life Sciences, Hasselt University, Belgium
| | - Wietse Vermeylen
- Rehabilitaion Research Center (REVAL), Biomedical Research Institute (BIOMED), Faculty of Medicine and Life Sciences, Hasselt University, Belgium
| | - Joke Spildooren
- Rehabilitaion Research Center (REVAL), Biomedical Research Institute (BIOMED), Faculty of Medicine and Life Sciences, Hasselt University, Belgium
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Bettecken K, Bernhard F, Sartor J, Hobert MA, Hofmann M, Gladow T, van Uem JMT, Liepelt-Scarfone I, Maetzler W. No relevant association of kinematic gait parameters with Health-related Quality of Life in Parkinson's disease. PLoS One 2017; 12:e0176816. [PMID: 28531171 PMCID: PMC5439666 DOI: 10.1371/journal.pone.0176816] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 04/18/2017] [Indexed: 10/30/2022] Open
Abstract
BACKGROUND Health-related Quality of Life (HrQoL) is probably the most important outcome parameter for the evaluation and management of chronic diseases. As this parameter is subjective and prone to bias, there is an urgent need to identify objective surrogate markers. Gait velocity has been shown to be associated with HrQoL in numerous chronic diseases, such as Parkinson's disease (PD). With the development and wide availability of simple-to-use wearable sensors and sophisticated gait algorithms, kinematic gait parameters may soon be implemented in clinical routine management. However, the association of such kinematic gait parameters with HrQoL in PD has not been assessed to date. METHODS Kinematic gait parameters from a 20-meter walk from 43 PD patients were extracted using a validated wearable sensor system. They were compared with the Visual Analogue Scale of the Euro-Qol-5D (EQ-5D VAS) by performing a multiple regression analysis, with the International Classification of Functioning, Disability and Health (ICF) model as a framework. RESULTS Use of assistive gait equipment, but no kinematic gait parameter, was significantly associated with HrQoL. CONCLUSION The widely accepted concept of a positive association between gait velocity and HrQoL may, at least in PD, be driven by relatively independent parameters, such as assistive gait equipment.
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Affiliation(s)
- Kristina Bettecken
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Felix Bernhard
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Jennifer Sartor
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Markus A. Hobert
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | | | - Till Gladow
- Hasomed, Magdeburg, Germany
- Institute for Physiotherapy, Department of Clinical Research, Jena University Hospital, Jena, Germany
| | - Janet M. T. van Uem
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Inga Liepelt-Scarfone
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Walter Maetzler
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
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Micó-Amigo ME, Kingma I, Faber GS, Kunikoshi A, van Uem JMT, van Lummel RC, Maetzler W, van Dieën JH. Is the Assessment of 5 Meters of Gait with a Single Body-Fixed-Sensor Enough to Recognize Idiopathic Parkinson's Disease-Associated Gait? Ann Biomed Eng 2017; 45:1266-1278. [PMID: 28108943 PMCID: PMC5397518 DOI: 10.1007/s10439-017-1794-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 12/29/2016] [Indexed: 11/28/2022]
Abstract
Quantitative assessment of gait in patients with Parkinson’s disease (PD) is an important step in addressing motor symptoms and improving clinical management. Based on the assessment of only 5 meters of gait with a single body-fixed-sensor placed on the lower back, this study presents a method for the identification of step-by-step kinematic parameters in 14 healthy controls and in 28 patients at early-to-moderate stages of idiopathic PD. Differences between groups in step-by-step kinematic parameters were evaluated to understand gait impairments in the PD group. Moreover, a discriminant model between groups was built from a subset of significant and independent parameters and based on a 10-fold cross-validated model. The discriminant model correctly classified a total of 89.5% participants with four kinematic parameters. The sensitivity of the model was 95.8% and the specificity 78.6%. The results indicate that the proposed method permitted to reasonably recognize idiopathic PD-associated gait from 5-m walking assessments. This motivates further investigation on the clinical utility of short episodes of gait assessment with body-fixed-sensors.
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Affiliation(s)
- M E Micó-Amigo
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. .,McRoberts B.V., Raamweg 43, 2596 HN, The Hague, The Netherlands.
| | - I Kingma
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - G S Faber
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - A Kunikoshi
- McRoberts B.V., Raamweg 43, 2596 HN, The Hague, The Netherlands
| | - J M T van Uem
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, Center of Neurology, University of Tübingen, Tübingen, Germany.,DZNE, German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - R C van Lummel
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,McRoberts B.V., Raamweg 43, 2596 HN, The Hague, The Netherlands
| | - W Maetzler
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, Center of Neurology, University of Tübingen, Tübingen, Germany.,DZNE, German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - J H van Dieën
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Evans T, Jefferson A, Byrnes M, Walters S, Ghosh S, Mastaglia FL, Power B, Anderton RS. Extended "Timed Up and Go" assessment as a clinical indicator of cognitive state in Parkinson's disease. J Neurol Sci 2017; 375:86-91. [PMID: 28320196 DOI: 10.1016/j.jns.2017.01.050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 01/02/2017] [Accepted: 01/16/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate a modified extended Timed Up and Go (extended-TUG) assessment against a panel of validated clinical assessments, as an indicator of Parkinson's disease (PD) severity and cognitive impairment. METHODS Eighty-seven participants with idiopathic PD were sequentially recruited from a Movement Disorders Clinic. An extended-TUG assessment was employed which required participants to stand from a seated position, walk in a straight line for 7m, turn 180° and then return to the start, in a seated position. The extended-TUG assessment duration was correlated to a panel of clinical assessments, including the Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Quality of Life (PDQ-39), Scales for Outcomes in Parkinson's Disease (SCOPA-Cog), revised Addenbrooke's Cognitive Index (ACE-R) and Barratt's Impulsivity Scale 11 (BIS-11). RESULTS Extended-TUG time was significantly correlated to MDS-UPDRS III score and to SCOPA-Cog, ACE-R (p<0.001) and PDQ-39 scores (p<0.01). Generalized linear models determined the extended-TUG to be a sole variable in predicting ACE-R or SCOPA-Cog scores. Patients in the fastest extended-TUG tertile were predicted to perform 8.3 and 13.4 points better in the SCOPA-Cog and ACE-R assessments, respectively, than the slowest group. Patients who exceeded the dementia cut-off scores with these instruments exhibited significantly longer extended-TUG times. CONCLUSIONS Extended-TUG performance appears to be a useful indicator of cognition as well as motor function and quality of life in PD, and warrants further evaluation as a first line assessment tool to monitor disease severity and response to treatment. Poor extended-TUG performance may identify patients without overt cognitive impairment form whom cognitive assessment is needed.
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Affiliation(s)
- Tess Evans
- School of Medicine, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Alexa Jefferson
- Western Australian Neuroscience Research Institute, A Block, QEII Medical Centre, Nedlands, WA, Australia
| | - Michelle Byrnes
- Western Australian Neuroscience Research Institute, A Block, QEII Medical Centre, Nedlands, WA, Australia; Centre for Neuromuscular and Neurological Disorders, University of Western Australia, Nedlands, WA, Australia
| | - Sue Walters
- Western Australian Neuroscience Research Institute, A Block, QEII Medical Centre, Nedlands, WA, Australia; Centre for Neuromuscular and Neurological Disorders, University of Western Australia, Nedlands, WA, Australia
| | - Soumya Ghosh
- Western Australian Neuroscience Research Institute, A Block, QEII Medical Centre, Nedlands, WA, Australia; Centre for Neuromuscular and Neurological Disorders, University of Western Australia, Nedlands, WA, Australia
| | - Frank L Mastaglia
- Western Australian Neuroscience Research Institute, A Block, QEII Medical Centre, Nedlands, WA, Australia; Centre for Neuromuscular and Neurological Disorders, University of Western Australia, Nedlands, WA, Australia; Institute of Immunology and Infectious Diseases, Murdoch University, Perth, WA, Australia
| | - Brian Power
- School of Medicine, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Ryan S Anderton
- Western Australian Neuroscience Research Institute, A Block, QEII Medical Centre, Nedlands, WA, Australia; Centre for Neuromuscular and Neurological Disorders, University of Western Australia, Nedlands, WA, Australia; School of Health Sciences, University of Notre Dame Australia, Fremantle, WA, Australia.
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Pal G, O'Keefe J, Robertson-Dick E, Bernard B, Anderson S, Hall D. Global cognitive function and processing speed are associated with gait and balance dysfunction in Parkinson's disease. J Neuroeng Rehabil 2016; 13:94. [PMID: 27793167 PMCID: PMC5084375 DOI: 10.1186/s12984-016-0205-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 10/25/2016] [Indexed: 12/25/2022] Open
Abstract
Background Our primary objective was to determine the relationship between global cognitive function and specific domains of gait and balance in a cohort of Parkinson’s disease (PD) subjects. In a secondary analysis, we determined whether specific cognitive domains correlated with gait and balance performance. Methods Fourteen PD subjects (mean age 61.1 ± 7.8 years) were recruited from the Rush University Medical Center Movement Disorders clinic. Subjects underwent clinical assessment using the motor subsection of the Unified Parkinson’s Disease Rating Scale (UPDRS) followed by quantitative gait and balance assessments using the APDM Mobility Lab™ system (Mobility Lab, APDM Inc., Portland, OR). Subjects completed global cognitive testing using the Mattis Dementia Rating Scale (MDRS) as well as domain specific cognitive measures. Spearman’s rho was used to assess correlations between cognitive measures and gait and balance function, with False Discovery Rate (FDR) correction for multiple comparisons. Results Global cognitive function had the strongest correlation with stride velocity (r = 0.816, p = 0.001), turn duration (r = −0.806, p = 0.001), number of steps to turn (r = −0.830, p = 0.001), and mean velocity of postural sway in the medio-lateral direction (r = −0.726, p = 0.005). A significant correlation was found between processing speed and two turning measures (turn duration, r = −0.884, p = 0.001; number of steps to turn, r = −0.954, p < 0.001), but no other associations were found between specific cognitive domains and gait domains. Conclusions This pilot study provides preliminary data regarding the association between global cognitive function and pace-related measures of gait, turning, and postural sway. Furthermore, reduced processing speed was found to be associated with difficulty in performing turns.
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Affiliation(s)
- Gian Pal
- Department of Neurological Sciences, Rush University, Chicago, IL, USA. .,Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Joan O'Keefe
- Department of Neurological Sciences, Rush University, Chicago, IL, USA.,Department of Anatomy and Cell Biology, Rush University, Chicago, IL, USA
| | | | - Bryan Bernard
- Department of Neurological Sciences, Rush University, Chicago, IL, USA
| | - Sharlet Anderson
- Department of Neurological Sciences, Rush University, Chicago, IL, USA
| | - Deborah Hall
- Department of Neurological Sciences, Rush University, Chicago, IL, USA
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