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Walz ID, Waibel S, Lippi V, Kammermeier S, Gollhofer A, Maurer C. "PNP slows down" - linearly-reduced whole body joint velocities and altered gait patterns in polyneuropathy. Front Hum Neurosci 2023; 17:1229440. [PMID: 37780958 PMCID: PMC10534044 DOI: 10.3389/fnhum.2023.1229440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction Gait disturbances are a common consequence of polyneuropathy (PNP) and a major factor in patients' reduced quality of life. Less is known about the underlying mechanisms of PNP-related altered motor behavior and its distribution across the body. We aimed to capture whole body movements in PNP during a clinically relevant mobility test, i.e., the Timed Up and Go (TUG). We hypothesize that joint velocity profiles across the entire body would enable a deeper understanding of PNP-related movement alterations. This may yield insights into motor control mechanisms responsible for altered gait in PNP. Methods 20 PNP patients (61 ± 14 years) and a matched healthy control group (CG, 60 ± 15 years) performed TUG at (i) preferred and (ii) fast movement speed, and (iii) while counting backward (dual-task). We recorded TUG duration (s) and extracted gait-related parameters [step time (s), step length (cm), and width (cm)] during the walking sequences of TUG and calculated center of mass (COM) velocity [represents gait speed (cm/s)] and joint velocities (cm/s) (ankles, knees, hips, shoulders, elbows, wrists) with respect to body coordinates during walking; we then derived mean joint velocities and ratios between groups. Results Across all TUG conditions, PNP patients moved significantly slower (TUG time, gait speed) with prolonged step time and shorter steps compared to CG. Velocity profiles depend significantly on group designation, TUG condition, and joint. Correlation analysis revealed that joint velocities and gait speed are closely interrelated in individual subjects, with a 0.87 mean velocity ratio between groups. Discussion We confirmed a PNP-related slowed gait pattern. Interestingly, joint velocities in the rest of the body measured in body coordinates were in a linear relationship to each other and to COM velocity in space coordinates, despite PNP. Across the whole body, PNP patients reduce, on average, their joint velocities with a factor of 0.87 compared to CG and thus maintain movement patterns in terms of velocity distributions across joints similarly to healthy individuals. This down-scaling of mean absolute joint velocities may be the main source for the altered motor behavior of PNP patients during gait and is due to the poorer quality of their somatosensory information. Clinical Trial Registration https://drks.de/search/de, identifier DRKS00016999.
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Affiliation(s)
- Isabelle D. Walz
- Department of Neurology and Neuroscience, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
- Department of Sport and Sport Science, University of Freiburg, Freiburg, Germany
| | - Sarah Waibel
- Department of Neurology and Neuroscience, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Vittorio Lippi
- Department of Neurology and Neuroscience, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
- Faculty of Medicine Freiburg, Institute of Digitalization in Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | | | - Albert Gollhofer
- Department of Sport and Sport Science, University of Freiburg, Freiburg, Germany
| | - Christoph Maurer
- Department of Neurology and Neuroscience, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
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Silsby M, Yiannikas C, Fois AF, Ng K, Kiernan MC, Fung VSC, Vucic S. Imbalance and lower limb tremor in chronic inflammatory demyelinating polyradiculoneuropathy. J Peripher Nerv Syst 2023; 28:415-424. [PMID: 37314215 DOI: 10.1111/jns.12574] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/08/2023] [Accepted: 06/11/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND AIMS Imbalance is a prominent symptom of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Although upper limb tremor in CIDP is described, lower limb tremor has not been assessed. The aim of this study was to determine whether lower limb tremor was present in CIDP and assess potential relationships with imbalance. METHODS This was a cross-sectional observational study of prospectively recruited consecutive patients with typical CIDP (N = 25). Clinical phenotyping, lower limb nerve conduction and tremor studies, and posturography analyses were performed. The Berg Balance Scale (BBS) divided CIDP patients into those with "good" and "poor" balance. RESULTS Lower limb tremor was evident in 32% of CIDP patients and associated with poor balance (BBSTremor 35 [23-46], BBSNo Tremor 52 [44-55], p = .035). Tremor frequency was 10.2-12.5 Hz with legs outstretched and on standing, apart from four patients with a lower frequency tremor (3.8-4.6 Hz) while standing. Posturography analysis revealed a high-frequency spectral peak in the vertical axis in 44% of CIDP patients (16.0 ± 0.4 Hz). This was more likely in those with "good" balance (40% vs. 4%, p = .013). INTERPRETATION Lower limb tremor is present in one third of CIDP patients and is associated with poor balance. A high-frequency peak on posturography is associated with better balance in CIDP. Lower limb tremor and posturography assessments could serve as important biomarkers of balance in a clinical setting.
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Affiliation(s)
- Matthew Silsby
- Neurology Department, Westmead Hospital Sydney & Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- Brain and Nerve Research Centre, Concord Hospital, University of Sydney, Sydney, Australia
- Neurology Department, Concord Hospital Sydney, Sydney, Australia
| | - Con Yiannikas
- Neurology Department, Concord Hospital Sydney, Sydney, Australia
- Neurology Department, Royal North Shore Hospital Sydney & Sydney Medical School, University of Sydney, Sydney, Australia
| | - Alessandro F Fois
- Neurology Department, Westmead Hospital Sydney & Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Karl Ng
- Neurology Department, Royal North Shore Hospital Sydney & Sydney Medical School, University of Sydney, Sydney, Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, University of Sydney & Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia
| | - Victor S C Fung
- Neurology Department, Westmead Hospital Sydney & Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Steve Vucic
- Brain and Nerve Research Centre, Concord Hospital, University of Sydney, Sydney, Australia
- Neurology Department, Concord Hospital Sydney, Sydney, Australia
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Delval A, Bayot M, Lapoulvereyrie R, Defebvre L, Vermersch P, Tard C. Role of the peripheral nervous system for an appropriate postural preparation during gait initiation in patients with a chronic inflammatory demyelinating polyneuropathy: A pilot study. Gait Posture 2021; 90:29-35. [PMID: 34371225 DOI: 10.1016/j.gaitpost.2021.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 07/29/2021] [Accepted: 08/02/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Gait initiation is an automatized motor program that is preceded by anticipatory postural adjustments (APAs). During attentional tasks, these APAs can be modulated, producing multiple APAs. However, the role of the peripheral nervous system in the regulation of these APAs is unknown. RESEARCH QUESTION The objective of our study was to investigate whether APAs are also regulated by peripheral nervous afferents. METHODS We assessed 21 patients suffering from chronic inflammatory demyelinating neuropathy and 20 healthy controls. Participants initiated gait with the right or left leg either freely (in the standard condition) or according to a visual trigger (i.e., the select condition). Kinetic and kinematic parameters of APAs and step initiation were recorded. RESULTS The select condition was related to a higher rate of multiple APAs compared to the standard condition, and was more attention-consuming in both groups. The group with a neuropathy showed longer APAs than the control group, associated with a longer time to recover from multiple APAs. Consequently, the step execution time was delayed in patients with a peripheral neuropathy. SIGNIFICANCE The impairment of the peripheral nervous system is therefore responsible for an alteration of the mechanisms underlying the recovery from multiple APAs during gait initiation. Our results are in favor of a role of proprioceptive afferents in the early peripheral regulation of motor errors. Further study on gait initiation in peripheral nervous disease could be helpful to better explore sensory-motor coupling in tasks requiring balance control.
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Affiliation(s)
- Arnaud Delval
- Univ. Lille, Inserm U1172- Lille Neurosciences Cognition, CHU Lille, F-59000, Lille, France.
| | - Madli Bayot
- Univ. Lille, Inserm U1172- Lille Neurosciences Cognition, CHU Lille, F-59000, Lille, France
| | | | - Luc Defebvre
- Univ. Lille, Inserm U1172- Lille Neurosciences Cognition, CHU Lille, F-59000, Lille, France
| | - Patrick Vermersch
- Univ. Lille, Inserm U1172- Lille Neurosciences Cognition, CHU Lille, F-59000, Lille, France
| | - Céline Tard
- Univ. Lille, Inserm U1172- Lille Neurosciences Cognition, CHU Lille, F-59000, Lille, France
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Silsby M, Yiannikas C, Ng K, Kiernan MC, Fung VSC, Vucic S. Posturography as a biomarker of intravenous immunoglobulin efficacy in chronic inflammatory demyelinating polyradiculoneuropathy. Muscle Nerve 2021; 65:43-50. [PMID: 34383335 DOI: 10.1002/mus.27398] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 08/03/2021] [Accepted: 08/07/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION/AIMS Imbalance is a common feature of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Intravenous immunoglobulin (IVIg) exerts clinical benefit in CIDP, including improving balance, although objective markers of efficacy are lacking. Posturography is an established objective marker of balance; therefore, this study aimed to determine the utility of posturography as an objective marker of treatment efficacy in CIDP. METHODS Posturography was performed on 18 CIDP patients, established on IVIg infusions, and results were compared to age-matched healthy controls. CIDP patients were assessed just prior to IVIg infusion and at the mid-point of the cycle. Center of pressure (CoP) was measured and the total path traveled by CoP (Sway Path, SP) was calculated for five different conditions: feet placed in parallel 16 cm apart at the medial border with eyes open (16cmEO) and eyes closed (16cmEC); medial borders of the feet touching with eyes open (0cmEO) and eyes closed (0cmEC); and tandem stance. RESULTS The sway path (SP) was significantly increased in CIDP patients (mean SP 1191 ± 104 mm) when compared to healthy controls (mean SP 724 ± 26 mm, P < .001). The increase was most prominent during eyes closed and tandem stance conditions. Treatment with IVIg significantly reduced SP when assessing 0cmEC (1759 ± 324 mm vs. 1081 ± 134 mm, P = .019) and tandem stance (1775 ± 290 mm vs. 1152 ± 113 mm, P = .027). DISCUSSION Posturography detected significant improvements in balance following IVIg in CIDP patients established on maintenance therapy. As such, posturography may be considered an objective marker of treatment response in clinical management and therapeutic trials.
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Affiliation(s)
- Matthew Silsby
- Neurology Department, Westmead Hospital Sydney, Westmead, New South Wales, Australia.,Neurology Department, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Con Yiannikas
- Neurology Department, Concord Hospital Sydney, Sydney, New South Wales, Australia.,Neurology Department, Royal North Shore Hospital Sydney & Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Karl Ng
- Neurology Department, Royal North Shore Hospital Sydney & Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia.,Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Victor S C Fung
- Neurology Department, Westmead Hospital Sydney, Westmead, New South Wales, Australia.,Neurology Department, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Steve Vucic
- Neurology Department, Westmead Hospital Sydney, Westmead, New South Wales, Australia.,Neurology Department, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Correlations Between Multi-plane vHIT Responses and Balance Control After Onset of an Acute Unilateral Peripheral Vestibular Deficit. Otol Neurotol 2021; 41:e952-e960. [PMID: 32658113 DOI: 10.1097/mao.0000000000002482] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Previous studies reported that balance deficits in pitch (sagittal) and roll (lateral) planes during stance and gait after onset of an acute unilateral peripheral vestibular deficit (aUPVD) due to vestibular neuritis are weakly correlated with deficits in commonly explored lateral canal vestibular ocular reflex (VOR) responses. Theoretically, stronger correlations with roll and pitch balance deficits could be expected for vertical canal VOR responses. Therefore, we investigated these correlations. SETTING University Hospital. STUDY DESIGN Retrospective case review. PATIENTS Thirty three patients examined on average 5 days following onset of aUPVD. MAIN OUTCOME MEASURES Video head impulse test (vHIT) VOR gains in each vertical canal plane were converted to roll and pitch response asymmetries and correlated with patients' roll and pitch balance control measured during stance and gait with body-worn gyroscopes mounted at lumbar 1 to 3. RESULTS Mean caloric canal paresis was 92 ± 12%. Deficit side lateral vHIT mean gain was 0.4 ± 0.12, anterior gain 0.44 ± 0.18, and posterior gain, greater, 0.69 ± 0.15. Lateral VOR response gain asymmetries (37.2 ± 11.0%) were greater than roll VOR asymmetries calculated from all four vertical canal vHIT gains (16.2 ± 10.2%, p < 0.0001) and correlated (R = 0.56, p = 0.002). Pitch gain VOR asymmetries were less (4.9 ± 9.9%, p < 0.0001). All gait, but no stance, trunk roll angular velocity measures were correlated (p ≤ 0.03) with VOR roll asymmetries. CONCLUSIONS This report links roll balance control deficits during gait with roll VOR deficits and emphasises the need to perform anterior canal vHIT to judge effects of an aUPVD on balance control. Pitch VOR asymmetries were weakly affected by vestibular neuritis.
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Wearable Health Technology to Quantify the Functional Impact of Peripheral Neuropathy on Mobility in Parkinson's Disease: A Systematic Review. SENSORS 2020; 20:s20226627. [PMID: 33228056 PMCID: PMC7699399 DOI: 10.3390/s20226627] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/12/2020] [Accepted: 11/17/2020] [Indexed: 12/11/2022]
Abstract
The occurrence of peripheral neuropathy (PNP) is often observed in Parkinson’s disease (PD) patients with a prevalence up to 55%, leading to more prominent functional deficits. Motor assessment with mobile health technologies allows high sensitivity and accuracy and is widely adopted in PD, but scarcely used for PNP assessments. This review provides a comprehensive overview of the methodologies and the most relevant features to investigate PNP and PD motor deficits with wearables. Because of the lack of studies investigating motor impairments in this specific subset of PNP-PD patients, Pubmed, Scopus, and Web of Science electronic databases were used to summarize the state of the art on PNP motor assessment with wearable technology and compare it with the existing evidence on PD. A total of 24 papers on PNP and 13 on PD were selected for data extraction: The main characteristics were described, highlighting major findings, clinical applications, and the most relevant features. The information from both groups (PNP and PD) was merged for defining future directions for the assessment of PNP-PD patients with wearable technology. We established suggestions on the assessment protocol aiming at accurate patient monitoring, targeting personalized treatments and strategies to prevent falls and to investigate PD and PNP motor characteristics.
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Bozovic I, Peric S, Basta I, Rakocevic-Stojanovic V, Lavrnic D, Stevic Z, Radovanovic S. Prospective analysis of gait characteristics in chronic inflammatory demyelinating polyradiculoneuropathy. J Clin Neurosci 2020; 80:6-10. [DOI: 10.1016/j.jocn.2020.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/07/2020] [Accepted: 08/03/2020] [Indexed: 12/14/2022]
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Sremakaew M, Sungkarat S, Treleaven J, Uthaikhup S. Effects of tandem walk and cognitive and motor dual- tasks on gait speed in individuals with chronic idiopathic neck pain: a preliminary study. Physiother Theory Pract 2019; 37:1210-1216. [PMID: 31671008 DOI: 10.1080/09593985.2019.1686794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Gait impairment has been associated with neck pain. It is relevant to understand the possible influence of narrow-based walk and an attention-demanding secondary task on gait performance in neck pain.Purpose: To investigate the effects of tandem walk and cognitive and motor dual-tasks on gait speed in persons with chronic idiopathic neck pain (CINP) compared with controls.Methods: A cross-sectional study. Thirty participants with CINP and 30 asymptomatic controls participated in the study. Gait speed was assessed using a timed 10-m walk test at a comfortable pace under four conditions: (1) comfortable walk (as reference); (2) tandem walk (single task); (3) cognitive dual-task walking; and (4) motor dual-task walking. Dual-task interference was calculated.Results: There was no difference in comfortable gait speed between groups (p= 0.40). The CINP group had slower gait speed during the tandem walk than controls (p= 0.02). The dual-task interference on gait speed was not different between groups (p = 0.67 for cognitive, p = 0.93 for motor).Conclusion: Participants with CINP had impaired gait stability during tandem walk. An attention-demanding secondary task did not influence gait speed in individuals with CINP compared to controls. The study suggests that tandem walk could be considered as an assessment tool and part of rehabilitation for neck pain.
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Affiliation(s)
- Munlika Sremakaew
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Somporn Sungkarat
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Julia Treleaven
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Sureeporn Uthaikhup
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
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Findling O, Rust H, Yaldizli Ö, Timmermans DPH, Scheltinga A, Allum JHJ. Balance Changes in Patients With Relapsing-Remitting Multiple Sclerosis: A Pilot Study Comparing the Dynamics of the Relapse and Remitting Phases. Front Neurol 2018; 9:686. [PMID: 30186223 PMCID: PMC6110896 DOI: 10.3389/fneur.2018.00686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 07/30/2018] [Indexed: 11/15/2022] Open
Abstract
Aims: To compare balance changes over time during the relapse phase of relapsing-remitting multiple sclerosis (RRMS) with balance control during the remitting phase. Methods: Balance control during stance and gait tasks of 24 remitting-phase patients (mean age 43.7 ± 10.5, 15 women, mean EDSS at baseline 2.45 ± 1.01) was examined every 3 months over 9 months and compared to that of nine relapsing patients (age 42.0 ± 12.7, all women, mean EDSS at relapse onset 3.11 ± 0.96) examined at relapse onset and 3 months later. Balance was also compared to that of 40 healthy controls (HCs) (age 39.7 ± 12.6, 25 women). Balance control was measured as lower-trunk sway angles with body-worn gyroscopes. Expanded Disability Status Scale scores (EDSS) were used to monitor, clinically, disease progression. Results: Remitting-phase patients showed more unstable stance balance control than HCs (p < 0.04) with no worsening over the observation period of 9 months. Gait balance control was normal (p > 0.06). Relapsing patients had stance balance control significantly worse at onset compared to remitting-phase patients and HCs (p < 0.04). Gait tasks showed a significant decrease of gait speed and trunk sway in relapsing patients (p = 0.018) compatible with having increased gait instability at normal speeds. Improvement to levels of remitting patients generally took longer than 3 months. Balance and EDSS scores were correlated for remitting but not for relapse patients. Conclusions: Balance in remitting RRMS patients does not change significantly over 9 months and correlated well with EDSS scores. Our results indicate that balance control is a useful measure to assess recovery after a relapse, particularly in patients with unchanged EDSS scores. Based on our results, balance could be considered as additional measurement to assess recovery after a relapse, particularly in patients with unchanged EDSS.
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Affiliation(s)
- Oliver Findling
- Department of Neurology, University of Basel Hospital, Basel, Switzerland
- Department of Neurology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Heiko Rust
- Department of Neurology, University of Basel Hospital, Basel, Switzerland
- Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, United Kingdom
| | - Özgür Yaldizli
- Department of Neurology, University of Basel Hospital, Basel, Switzerland
| | - Dionne P. H. Timmermans
- Radboud University Nijmegen, Nijmegen, Netherlands
- Division of Audiology and Neurootology, Department of ORL, University of Basel Hospital, Basel, Switzerland
| | - Alja Scheltinga
- Radboud University Nijmegen, Nijmegen, Netherlands
- Division of Audiology and Neurootology, Department of ORL, University of Basel Hospital, Basel, Switzerland
| | - John H. J. Allum
- Department of Neurology, University of Basel Hospital, Basel, Switzerland
- Division of Audiology and Neurootology, Department of ORL, University of Basel Hospital, Basel, Switzerland
- *Correspondence: John H. J. Allum
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