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Le Roy A, Dubois F, Roche N, Brunel H, Bonnyaud C. Cautious Gait during Navigational Tasks in People with Hemiparesis: An Observational Study. SENSORS (BASEL, SWITZERLAND) 2024; 24:4241. [PMID: 39001018 PMCID: PMC11244485 DOI: 10.3390/s24134241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/25/2024] [Accepted: 06/26/2024] [Indexed: 07/16/2024]
Abstract
Locomotor and balance disorders are major limitations for subjects with hemiparesis. The Timed Up and Go (TUG) test is a complex navigational task involving oriented walking and obstacle circumvention. We hypothesized that subjects with hemiparesis adopt a cautious gait during complex locomotor tasks. The primary aim was to compare spatio-temporal gait parameters, indicators of cautious gait, between the locomotor subtasks of the TUG (Go, Turn, Return) and a Straight-line walk in people with hemiparesis. Our secondary aim was to analyze the relationships between TUG performance and balance measures, compare spatio-temporal gait parameters between fallers and non-fallers, and identify the biomechanical determinants of TUG performance. Biomechanical parameters during the TUG and Straight-line walk were analyzed using a motion capture system. A repeated measures ANOVA and two stepwise ascending multiple regressions (with performance variables and biomechanical variables) were conducted. Gait speed, step length, and % single support phase (SSP) of the 29 participants were reduced during Turn compared to Go and Return and the Straight-line walk, and step width and % double support phase were increased. TUG performance was related to several balance measures. Turn performance (R2 = 63%) and Turn trajectory deviation followed by % SSP on the paretic side and the vertical center of mass velocity during Go (R2 = 71%) determined TUG performance time. People with hemiparesis adopt a cautious gait during complex navigation at the expense of performance.
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Affiliation(s)
- Albane Le Roy
- APHP, GHU Paris-Saclay, Raymond Poincaré Hospital, Physical Medicine and Rehabilitation Department, 92380 Garches, France
- IFMK Saint-Michel, 75015 Paris, France
| | - Fabien Dubois
- APHP, GHU Paris-Saclay, Raymond Poincaré Hospital, Motion Analysis Laboratory, Functional Explorations Department, 92380 Garches, France
- Université Paris-Saclay, UVSQ, Research Unit ERPHAN, 78000 Versailles, France
| | - Nicolas Roche
- APHP, GHU Paris-Saclay, Raymond Poincaré Hospital, Motion Analysis Laboratory, Functional Explorations Department, 92380 Garches, France
- Université Paris-Saclay, UVSQ, Inserm Unit 1179, END-ICAP Laboratory, 78000 Versailles, France
| | | | - Céline Bonnyaud
- IFMK Saint-Michel, 75015 Paris, France
- APHP, GHU Paris-Saclay, Raymond Poincaré Hospital, Motion Analysis Laboratory, Functional Explorations Department, 92380 Garches, France
- Université Paris-Saclay, UVSQ, Research Unit ERPHAN, 78000 Versailles, France
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Giardini M, Turcato AM, Arcolin I, Corna S, Godi M. Vertical Ground Reaction Forces in Parkinson's Disease: A Speed-Matched Comparative Analysis with Healthy Subjects. SENSORS (BASEL, SWITZERLAND) 2023; 24:179. [PMID: 38203042 PMCID: PMC10781249 DOI: 10.3390/s24010179] [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: 11/21/2023] [Revised: 12/20/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024]
Abstract
This study aimed to investigate and compare the vertical Ground Reaction Forces (vGRFs) of patients with Parkinson's Disease (PwPD) and healthy subjects (HS) when the confounding effect of walking speed was absent. Therefore, eighteen PwPD and eighteen age- and linear walking speed-matched HS were recruited. Using plantar pressure insoles, participants walked along linear and curvilinear paths at self-selected speeds. Interestingly, PwPD exhibited similar walking speed to HS during curvilinear trajectories (p = 0.48) and similar vGRF during both linear and curvilinear paths. In both groups, vGRF at initial contact and terminal stance was higher during linear walking, while vGRF at mid-stance was higher in curvilinear trajectories. Similarly, the time to peak vGRF at each phase showed no significant group differences. The vGRF timing variability was different between the two groups, particularly at terminal stance (p < 0.001). In conclusion, PwPD and HS showed similar modifications in vGRF and a similar reduction in gait speed during curvilinear paths when matched for linear walking speed. This emphasized the importance of considering walking speed when assessing gait dynamics in PwPD. This study also suggests the possibility of the variability of specific temporal measures in differentiating the gait patterns of PwPD versus those of HS, even in the early stages of the disease.
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Affiliation(s)
- Marica Giardini
- Division of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Veruno, 28013 Gattico-Veruno, Italy; (M.G.); (S.C.); (M.G.)
| | - Anna Maria Turcato
- Rehabilitation Department, The Clavadel—The Geoghegan Group, 1 Pit Farm Road, Guildford GU1 2JH, Surrey, UK;
| | - Ilaria Arcolin
- Division of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Veruno, 28013 Gattico-Veruno, Italy; (M.G.); (S.C.); (M.G.)
| | - Stefano Corna
- Division of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Veruno, 28013 Gattico-Veruno, Italy; (M.G.); (S.C.); (M.G.)
| | - Marco Godi
- Division of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Veruno, 28013 Gattico-Veruno, Italy; (M.G.); (S.C.); (M.G.)
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Soke F, Erkoc Ataoglu NE, Ozcan Gulsen E, Yilmaz O, Gulsen C, Kocer B, Kirteke F, Basturk S, Comoglu SS, Tokcaer AB. The psychometric properties of the figure-of-eight walk test in people with Parkinson's disease. Disabil Rehabil 2023; 45:301-309. [PMID: 35191344 DOI: 10.1080/09638288.2022.2028020] [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] [Indexed: 01/12/2023]
Abstract
PURPOSE To investigate: (1) the interrater, and test-retest reliability of the figure-of-eight walk test (F8WT) in people with Parkinson's disease (PwPD); (2) the minimum detectable change in the F8WT times; (3) the concurrent and known-groups validity of the F8WT times; and (4) the cut-off times that best discriminate PwPD from healthy people and fallers from non-fallers with PD. METHODS This was a cross-sectional study. Forty-three PwPD and 34 healthy people were recruited. The F8WT was performed along with the timed up and go test, 10 m walk test, Berg Balance Scale, Activities-Specific Balance Confidence Scale, Unified Parkinson's disease Rating Scale, and Hoehn and Yahr Scale. RESULTS The F8WT showed good interrater and test-retest reliability (ICC = 0.964-0.978 and ICC = 0.905-0.920, respectively). The MDC was 2.77 s. The F8WT was correlated with other outcome measures. Significant differences in the F8WT times were found between PwPD and healthy people and between fallers and non-fallers with PD (p < 0.001 and p < 0.001, respectively). The cut-off times of 8.43 s best discriminated PwPD from healthy people, while 11.19 s best discriminated fallers from non-fallers with PD. CONCLUSIONS The F8WT is a reliable, valid, and easy-to-administer tool in assessing the walking skill of PwPD.Implications for rehabilitationThe figure-of-eight walk test (F8WT) is a reliable, valid, and clinically available tool for assessing walking skill in Parkinson's disease (PD).The minimal detectable change of the F8WT is 2.77 s, which may help to determine any real change in walking skill after any intervention.The F8WT correlated with functional mobility, gait speed, balance, balance confidence, and severity and stage of PD.The F8WT times may detect impaired walking skill between people with PD and healthy people, and between fallers and non-fallers with PD.
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Affiliation(s)
- Fatih Soke
- Department of Physiotherapy and Rehabilitation, Gulhane Faculty of Health Sciences, University of Health Sciences, Ankara, Turkey
| | | | - Elvan Ozcan Gulsen
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Yuksek Ihtisas University, Ankara, Turkey
| | - Oznur Yilmaz
- Department of Physiotherapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Cagri Gulsen
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Bilge Kocer
- Department of Neurology, Diskapi Yildirim Beyazit Teaching and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Fatos Kirteke
- Department of Ergotherapy, Faculty of Health Sciences, Fenerbahce University, Istanbul, Turkey
| | - Sultan Basturk
- Kanalboyu Physical Therapy and Rehabilitation Medical Center, Malatya, Turkey
| | - Selim Selcuk Comoglu
- Department of Neurology, Diskapi Yildirim Beyazit Teaching and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Ayse Bora Tokcaer
- Department of Neurology, Faculty of Medicine, Gazi University, Ankara, Turkey
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Parati M, Gallotta M, Muletti M, Pirola A, Bellafà A, De Maria B, Ferrante S. Validation of Pressure-Sensing Insoles in Patients with Parkinson's Disease during Overground Walking in Single and Cognitive Dual-Task Conditions. SENSORS (BASEL, SWITZERLAND) 2022; 22:6392. [PMID: 36080851 PMCID: PMC9460700 DOI: 10.3390/s22176392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/23/2022] [Accepted: 08/11/2022] [Indexed: 06/15/2023]
Abstract
There is a need for unobtrusive and valid tools to collect gait parameters in patients with Parkinson's disease (PD). The novel promising tools are pressure-sensing insoles connected to a smartphone app; however, few studies investigated their measurement properties during simple or challenging conditions in PD patients. This study aimed to examine the validity and reliability of gait parameters computed by pressure-sensing insoles (FeetMe® insoles, Paris, France). Twenty-five PD patients (21 males, mean age: 69 (7) years) completed two walking assessment sessions. In each session, participants walked on an electronic pressure-sensitive walkway (GaitRite®, CIR System Inc., Franklin, NJ, USA) without other additional instructions (i.e., single-task condition) and while performing a concurrent cognitive task (i.e., dual-task condition). Spatiotemporal gait parameters were measured simultaneously using the pressure-sensing insoles and the electronic walkway. Concurrent validity was assessed by correlation coefficients and Bland-Altman methodology. Test-retest reliability was examined by intraclass correlation coefficients (ICC) and minimal detectable changes (MDC). The validity results showed moderate to excellent correlations and good agreement between the two systems. Concerning test-retest reliability, moderate-to-excellent ICC values and acceptable MDC demonstrated the repeatability of the measured gait parameters. Our findings support the use of these insoles as complementary instruments to conventional tools during single and dual-task conditions.
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Affiliation(s)
- Monica Parati
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Italy
- Istituti Clinici Scientifici Maugeri IRCCS, 20138 Milan, Italy
| | - Matteo Gallotta
- Istituti Clinici Scientifici Maugeri IRCCS, 20138 Milan, Italy
| | - Manuel Muletti
- Istituti Clinici Scientifici Maugeri IRCCS, 20138 Milan, Italy
| | - Annalisa Pirola
- Istituti Clinici Scientifici Maugeri IRCCS, 20138 Milan, Italy
| | - Alice Bellafà
- Istituti Clinici Scientifici Maugeri IRCCS, 20138 Milan, Italy
| | | | - Simona Ferrante
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Italy
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Ávila de Oliveira J, Bazán PR, de Oliveira CEN, Treza RDC, Hondo SM, Los Angeles E, Bernardo C, de Oliveira LDS, Carvalho MDJ, de Lima-Pardini AC, Coelho DB. The effects of levodopa in the spatiotemporal gait parameters are mediated by self-selected gait speed in Parkinson's disease. Eur J Neurosci 2021; 54:8020-8028. [PMID: 34755397 DOI: 10.1111/ejn.15522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 11/27/2022]
Abstract
In individuals with Parkinson's disease (PD), the medication induces different and inconsistent results in the spatiotemporal parameters of gait, making it difficult to understand its effects on gait. As spatiotemporal gait parameters have been reported to be affected by gait speed, it is essential to consider the gait speed when studying walking biomechanics to interpret the results better when comparing the gait pattern of different conditions. Since the medication alters the self-selected gait speed of individuals with PD, this study analysed whether the change in gait speed can explain the selective effects of l-DOPA on the spatiotemporal parameters of gait in individuals with PD. We analysed the spatiotemporal gait parameters at the self-selected speed of 22 individuals with PD under ON and OFF states of l-DOPA medication. Bayesian mediation analysis evaluated which gait variables were affected by the medication state and checked if those effects were mediated by speed changes induced by medication. The gait speed was significantly higher among ON compared with OFF medication. All the spatiotemporal parameters of the gait were mediated by speed, with proportions of mediation close to 1 (effect entirely explained by speed changes). Our results show that a change in gait speed better explains the changes in the spatiotemporal gait parameters than the ON-OFF phenomenon. As an implication for rehabilitation, our results suggest that it is possible to assess the effect of l-DOPA on improving motor symptoms related to gait disorders by measuring gait speed.
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Affiliation(s)
- Júlia Ávila de Oliveira
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | | | | | - Renata de Castro Treza
- Center for Mathematics, Computation, and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
| | - Sandy Mikie Hondo
- Biomedical Engineering, Federal University of ABC, São Bernardo do Campo, Brazil
| | - Emanuele Los Angeles
- Center for Mathematics, Computation, and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
| | - Claudionor Bernardo
- Biomedical Engineering, Federal University of ABC, São Bernardo do Campo, Brazil
| | | | | | - Andrea C de Lima-Pardini
- Laboratory of Integrative Motor Behaviour, Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
| | - Daniel Boari Coelho
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil.,Center for Mathematics, Computation, and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil.,Biomedical Engineering, Federal University of ABC, São Bernardo do Campo, Brazil
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6
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Godi M, Arcolin I, Giardini M, Corna S, Schieppati M. A pathophysiological model of gait captures the details of the impairment of pace/rhythm, variability and asymmetry in Parkinsonian patients at distinct stages of the disease. Sci Rep 2021; 11:21143. [PMID: 34707168 PMCID: PMC8551236 DOI: 10.1038/s41598-021-00543-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/05/2021] [Indexed: 01/15/2023] Open
Abstract
Locomotion in people with Parkinson' disease (pwPD) worsens with the progression of disease, affecting independence and quality of life. At present, clinical practice guidelines recommend a basic evaluation of gait, even though the variables (gait speed, cadence, step length) may not be satisfactory for assessing the evolution of locomotion over the course of the disease. Collecting variables into factors of a conceptual model enhances the clinical assessment of disease severity. Our aim is to evaluate if factors highlight gait differences between pwPD and healthy subjects (HS) and do it at earlier stages of disease compared to single variables. Gait characteristics of 298 pwPD and 84 HS able to walk without assistance were assessed using a baropodometric walkway (GAITRite®). According to the structure of a model previously validated in pwPD, eight spatiotemporal variables were grouped in three factors: pace/rhythm, variability and asymmetry. The model, created from the combination of three factor scores, proved to outperform the single variables or the factors in discriminating pwPD from HS. When considering the pwPD split into the different Hoehn and Yahr (H&Y) stages, the spatiotemporal variables, factor scores and the model showed that multiple impairments of gait appear at H&Y stage 2.5, with the greatest difference from HS at stage 4. A contrasting behavior was found for the asymmetry variables and factor, which showed differences from the HS already in the early stages of PD. Our findings support the use of factor scores and of the model with respect to the single variables in gait staging in PD.
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Affiliation(s)
- Marco Godi
- Division of Physical Medicine and Rehabilitation, Scientific Institute of Veruno, Istituti Clinici Scientifici Maugeri IRCCS, 28010, Gattico-Veruno, NO, Italy
| | - Ilaria Arcolin
- Division of Physical Medicine and Rehabilitation, Scientific Institute of Veruno, Istituti Clinici Scientifici Maugeri IRCCS, 28010, Gattico-Veruno, NO, Italy.
| | - Marica Giardini
- Division of Physical Medicine and Rehabilitation, Scientific Institute of Veruno, Istituti Clinici Scientifici Maugeri IRCCS, 28010, Gattico-Veruno, NO, Italy
| | - Stefano Corna
- Division of Physical Medicine and Rehabilitation, Scientific Institute of Veruno, Istituti Clinici Scientifici Maugeri IRCCS, 28010, Gattico-Veruno, NO, Italy
| | - Marco Schieppati
- Scientific Institute of Pavia, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy
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Warmerdam E, Romijnders R, Geritz J, Elshehabi M, Maetzler C, Otto JC, Reimer M, Stuerner K, Baron R, Paschen S, Beyer T, Dopcke D, Eiken T, Ortmann H, Peters F, von der Recke F, Riesen M, Rohwedder G, Schaade A, Schumacher M, Sondermann A, Maetzler W, Hansen C. Proposed Mobility Assessments with Simultaneous Full-Body Inertial Measurement Units and Optical Motion Capture in Healthy Adults and Neurological Patients for Future Validation Studies: Study Protocol. SENSORS 2021; 21:s21175833. [PMID: 34502726 PMCID: PMC8434336 DOI: 10.3390/s21175833] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/24/2021] [Accepted: 08/27/2021] [Indexed: 01/06/2023]
Abstract
Healthy adults and neurological patients show unique mobility patterns over the course of their lifespan and disease. Quantifying these mobility patterns could support diagnosing, tracking disease progression and measuring response to treatment. This quantification can be done with wearable technology, such as inertial measurement units (IMUs). Before IMUs can be used to quantify mobility, algorithms need to be developed and validated with age and disease-specific datasets. This study proposes a protocol for a dataset that can be used to develop and validate IMU-based mobility algorithms for healthy adults (18–60 years), healthy older adults (>60 years), and patients with Parkinson’s disease, multiple sclerosis, a symptomatic stroke and chronic low back pain. All participants will be measured simultaneously with IMUs and a 3D optical motion capture system while performing standardized mobility tasks and non-standardized activities of daily living. Specific clinical scales and questionnaires will be collected. This study aims at building the largest dataset for the development and validation of IMU-based mobility algorithms for healthy adults and neurological patients. It is anticipated to provide this dataset for further research use and collaboration, with the ultimate goal to bring IMU-based mobility algorithms as quickly as possible into clinical trials and clinical routine.
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Ghislieri M, Agostini V, Rizzi L, Knaflitz M, Lanotte M. Atypical Gait Cycles in Parkinson's Disease. SENSORS (BASEL, SWITZERLAND) 2021; 21:5079. [PMID: 34372315 PMCID: PMC8347347 DOI: 10.3390/s21155079] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/21/2021] [Accepted: 07/23/2021] [Indexed: 12/15/2022]
Abstract
It is important to find objective biomarkers for evaluating gait in Parkinson's Disease (PD), especially related to the foot and lower leg segments. Foot-switch signals, analyzed through Statistical Gait Analysis (SGA), allow the foot-floor contact sequence to be characterized during a walking session lasting five-minutes, which includes turnings. Gait parameters were compared between 20 PD patients and 20 age-matched controls. PDs showed similar straight-line speed, cadence, and double-support compared to controls, as well as typical gait-phase durations, except for a small decrease in the flat-foot contact duration (-4% of the gait cycle, p = 0.04). However, they showed a significant increase in atypical gait cycles (+42%, p = 0.006), during both walking straight and turning. A forefoot strike, instead of a "normal" heel strike, characterized the large majority of PD's atypical cycles, whose total percentage was 25.4% on the most-affected and 15.5% on the least-affected side. Moreover, we found a strong correlation between the atypical cycles and the motor clinical score UPDRS-III (r = 0.91, p = 0.002), in the subset of PD patients showing an abnormal number of atypical cycles, while we found a moderate correlation (r = 0.60, p = 0.005), considering the whole PD population. Atypical cycles have proved to be a valid biomarker to quantify subtle gait dysfunctions in PD patients.
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Affiliation(s)
- Marco Ghislieri
- Department of Electronics and Telecommunications, Politecnico di Torino, 10129 Turin, Italy; (V.A.); (M.K.)
- PoliToBIOMed Lab, Politecnico di Torino, 10129 Turin, Italy
| | - Valentina Agostini
- Department of Electronics and Telecommunications, Politecnico di Torino, 10129 Turin, Italy; (V.A.); (M.K.)
- PoliToBIOMed Lab, Politecnico di Torino, 10129 Turin, Italy
| | - Laura Rizzi
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy; (L.R.); (M.L.)
- AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Marco Knaflitz
- Department of Electronics and Telecommunications, Politecnico di Torino, 10129 Turin, Italy; (V.A.); (M.K.)
- PoliToBIOMed Lab, Politecnico di Torino, 10129 Turin, Italy
| | - Michele Lanotte
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy; (L.R.); (M.L.)
- AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
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Zancan A, Sozzi S, Schieppati M. Basic Spatiotemporal Gait Variables of Young and Older Healthy Volunteers Walking Along a Novel Figure-of-8 Path. Front Neurol 2021; 12:698160. [PMID: 34168613 PMCID: PMC8217764 DOI: 10.3389/fneur.2021.698160] [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: 04/20/2021] [Accepted: 05/14/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Locomotion along curved trajectories requires fine coordination among body segments. Elderly people may adopt a cautious attitude when steering. A simple, expeditious, patient-friendly walking protocol can be a tool to help clinicians. We evaluated the feasibility of a procedure based upon a newly designed Figure-of-eight (nFo8) path and an easy measurement operation. Methods: Sixty healthy volunteers, aged from 20 to 86 years, walked three times at self-selected speed along a 20 m linear (LIN) and the 20 m nFo8 path. Number of steps, mean speed and walk ratio (step length/cadence) were collected. Data were analysed for the entire cohort and for the groups aged 20-45, 46-65, and >65 years. Results: There was no difference in mean LIN walking speed between the two younger groups but the oldest was slower. During nFo8, all groups were slower (about 16%) than during LIN. Cadence was not different across groups but lower during nFo8 in each group. Step length was about 8% shorter in the two younger groups and 14% shorter in the oldest during nFo8 compared to LIN. Walk ratio was the smallest in the oldest group for both LIN and nFo8. Conclusions: A complex nFo8 walking path, with fast and easy measurement of a simple set of variables, detects significant differences with moderate and large effects in gait variables in people >65 years. This challenging trajectory is more revealing than LIN. Further studies are needed to develop a quick clinical tool for assessment of gait conditions or outcome of rehabilitative treatments.
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Affiliation(s)
| | - Stefania Sozzi
- Centro Studi Attività Motorie, Neurorehabilitation and Spinal Unit, Istituti Clinici Scientifici Maugeri SB, Pavia, Italy
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Jiménez-Grande D, Farokh Atashzar S, Martinez-Valdes E, Marco De Nunzio A, Falla D. Kinematic biomarkers of chronic neck pain measured during gait: A data-driven classification approach. J Biomech 2021; 118:110190. [PMID: 33581443 DOI: 10.1016/j.jbiomech.2020.110190] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/27/2020] [Accepted: 12/11/2020] [Indexed: 12/30/2022]
Abstract
People with chronic neck pain (CNP) often present with altered gait kinematics. This paper investigates, combines, and compares the kinematic features from linear and nonlinear walking trajectories to design supervised machine learning models which differentiate asymptomatic individuals from those with CNP. For this, 126 features were extracted from seven body segments of 20 asymptomatic subjects and 20 individuals with non-specific CNP. Neighbourhood Component Analysis (NCA) was used to identify body segments and the corresponding significant features which have the maximum discriminative power for conducting classification. We assessed the efficacy of NCA combined with K- Nearest Neighbour (K-NN), Support Vector Machine and Linear Discriminant Analysis. By applying NCA, all classifiers increased their performance for both linear and nonlinear walking trajectories. Notably, features selected by NCA which magnify the classification power of the computational model were solely from the head, trunk and pelvis kinematics. Our results revealed that the nonlinear trajectory provides the best classification performance through the NCA-K-NN algorithms with an accuracy of 90%, specificity of 100% and sensitivity of 83.3%. The selected features by NCA are introduced as key biomarkers of gait kinematics for classifying non-specific CNP. This paper provides insight into changes in gait kinematics which are present in people with non-specific CNP which can be exploited for classification purposes. The result highlights the importance of curvilinear gait kinematic features which potentially could be utilized in future research to predict recurrent episodes of neck pain.
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Affiliation(s)
- David Jiménez-Grande
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK
| | - S Farokh Atashzar
- Electrical & Computer Engineering, as well as Mechanical & Aerospace Engineering at New York University (NYU), USA
| | - Eduardo Martinez-Valdes
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK
| | | | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK.
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Romijnders R, Warmerdam E, Hansen C, Welzel J, Schmidt G, Maetzler W. Validation of IMU-based gait event detection during curved walking and turning in older adults and Parkinson's Disease patients. J Neuroeng Rehabil 2021; 18:28. [PMID: 33549105 PMCID: PMC7866479 DOI: 10.1186/s12984-021-00828-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 01/26/2021] [Indexed: 11/16/2022] Open
Abstract
Background Identification of individual gait events is essential for clinical gait analysis, because it can be used for diagnostic purposes or tracking disease progression in neurological diseases such as Parkinson’s disease. Previous research has shown that gait events can be detected from a shank-mounted inertial measurement unit (IMU), however detection performance was often evaluated only from straight-line walking. For use in daily life, the detection performance needs to be evaluated in curved walking and turning as well as in single-task and dual-task conditions. Methods Participants (older adults, people with Parkinson’s disease, or people who had suffered from a stroke) performed three different walking trials: (1) straight-line walking, (2) slalom walking, (3) Stroop-and-walk trial. An optical motion capture system was used a reference system. Markers were attached to the heel and toe regions of the shoe, and participants wore IMUs on the lateral sides of both shanks. The angular velocity of the shank IMUs was used to detect instances of initial foot contact (IC) and final foot contact (FC), which were compared to reference values obtained from the marker trajectories. Results The detection method showed high recall, precision and F1 scores in different populations for both initial contacts and final contacts during straight-line walking (IC: recall \documentclass[12pt]{minimal}
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\begin{document}$$\ge$$\end{document}≥89%). Conclusions Shank-mounted IMUs can be used to detect gait events during straight-line walking, slalom walking and turning. However, more false events were observed during turning and more events were missed during turning. For use in daily life we recommend identifying turning before extracting temporal gait parameters from identified gait events.
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Affiliation(s)
- Robbin Romijnders
- Digital Signal Processing and System Theory, Institute of Electrical and Information Engineering, Kiel University, Kaiserstraße 2, 24143, Kiel, Germany. .,Neurogeriatrics, Department of Neurology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, Haus D, 24105, Kiel, Germany.
| | - Elke Warmerdam
- Digital Signal Processing and System Theory, Institute of Electrical and Information Engineering, Kiel University, Kaiserstraße 2, 24143, Kiel, Germany.,Neurogeriatrics, Department of Neurology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, Haus D, 24105, Kiel, Germany
| | - Clint Hansen
- Neurogeriatrics, Department of Neurology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, Haus D, 24105, Kiel, Germany
| | - Julius Welzel
- Neurogeriatrics, Department of Neurology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, Haus D, 24105, Kiel, Germany
| | - Gerhard Schmidt
- Digital Signal Processing and System Theory, Institute of Electrical and Information Engineering, Kiel University, Kaiserstraße 2, 24143, Kiel, Germany
| | - Walter Maetzler
- Neurogeriatrics, Department of Neurology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, Haus D, 24105, Kiel, Germany
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12
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Zanardi APJ, da Silva ES, Costa RR, Passos-Monteiro E, Dos Santos IO, Kruel LFM, Peyré-Tartaruga LA. Gait parameters of Parkinson's disease compared with healthy controls: a systematic review and meta-analysis. Sci Rep 2021; 11:752. [PMID: 33436993 PMCID: PMC7804291 DOI: 10.1038/s41598-020-80768-2] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 12/28/2020] [Indexed: 12/15/2022] Open
Abstract
We systematically reviewed observational and clinical trials (baseline) studies examining differences in gait parameters between Parkinson’s disease (PD) in on-medication state and healthy control. Four electronic databases were searched (November-2018 and updated in October-2020). Independent researchers identified studies that evaluated gait parameters measured quantitatively during self-selected walking speed. Risk of bias was assessed using an instrument proposed by Downs and Black (1998). Pooled effects were reported as standardized mean differences and 95% confidence intervals using a random-effects model. A total of 72 studies involving 3027 participants (1510 with PD and 1517 health control) met the inclusion criteria. The self-selected walking speed, stride length, swing time and hip excursion were reduced in people with PD compared with healthy control. Additionally, PD subjects presented higher cadence and double support time. Although with a smaller difference for treadmill, walking speed is reduced both on treadmill (.13 m s−1) and on overground (.17 m s−1) in PD. The self-select walking speed, stride length, cadence, double support, swing time and sagittal hip angle were altered in people with PD compared with healthy control. The precise determination of these modifications will be beneficial in determining which intervention elements are most critical in bringing about positive, clinically meaningful changes in individuals with PD (PROSPERO protocol CRD42018113042).
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Affiliation(s)
- Ana Paula Janner Zanardi
- Exercise Research Laboratory, Universidade Federal Do Rio Grande Do Sul, 750 Felizardo St, Porto Alegre, RS, 90690-200, Brazil.,Univel University Center, Cascavel, Brazil
| | - Edson Soares da Silva
- Exercise Research Laboratory, Universidade Federal Do Rio Grande Do Sul, 750 Felizardo St, Porto Alegre, RS, 90690-200, Brazil
| | - Rochelle Rocha Costa
- Exercise Research Laboratory, Universidade Federal Do Rio Grande Do Sul, 750 Felizardo St, Porto Alegre, RS, 90690-200, Brazil
| | - Elren Passos-Monteiro
- Exercise Research Laboratory, Universidade Federal Do Rio Grande Do Sul, 750 Felizardo St, Porto Alegre, RS, 90690-200, Brazil.,Laboratory of PhysioMechanics of Locomotion, Universidade Federal Do Pará, Castanhal, Brazil
| | - Ivan Oliveira Dos Santos
- Exercise Research Laboratory, Universidade Federal Do Rio Grande Do Sul, 750 Felizardo St, Porto Alegre, RS, 90690-200, Brazil
| | - Luiz Fernando Martins Kruel
- Exercise Research Laboratory, Universidade Federal Do Rio Grande Do Sul, 750 Felizardo St, Porto Alegre, RS, 90690-200, Brazil
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13
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Belluscio V, Bergamini E, Tramontano M, Formisano R, Buzzi MG, Vannozzi G. Does Curved Walking Sharpen the Assessment of Gait Disorders? An Instrumented Approach Based on Wearable Inertial Sensors. SENSORS 2020; 20:s20185244. [PMID: 32937877 PMCID: PMC7570481 DOI: 10.3390/s20185244] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/07/2020] [Accepted: 09/10/2020] [Indexed: 11/25/2022]
Abstract
Gait and balance assessment in the clinical context mainly focuses on straight walking. Despite that curved trajectories and turning are commonly faced in our everyday life and represent a challenge for people with gait disorders. The adoption of curvilinear trajectories in the rehabilitation practice could have important implications for the definition of protocols tailored on individual’s needs. The aim of this study was to contribute toward the quantitative characterization of straight versus curved walking using an ecological approach and focusing on healthy and neurological populations. Twenty healthy adults (control group (CG)) and 20 patients with Traumatic Brain Injury (TBI) (9 severe, sTBI-S, and 11 very severe, sTBI-VS) performed a 10 m and a Figure-of-8 Walk Test while wearing four inertial sensors that were located on both tibiae, sternum and pelvis. Spatiotemporal and gait quality indices that were related to locomotion stability, symmetry, and smoothness were obtained. The results show that spatiotemporal, stability, and symmetry-related gait patterns are challenged by curved walking both in healthy subjects and sTBI-S, whereas no difference was displayed for sTBI-VS. The use of straight walking alone to assess gait disorders is thus discouraged, particularly in patients with good walking abilities, in favor of the adoption of complementary tests that were also based on curved paths.
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Affiliation(s)
- Valeria Belluscio
- Department of Movement, Human and Health Sciences, Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, University of Rome “Foro Italico”, Piazza Lauro de Bosis 15, 00135 Roma, Italy; (V.B.); or (G.V.)
- IRCCS Santa Lucia Foundation, Via Ardeatina 306, 00179 Roma, Italy; (R.F.); (M.G.B.)
| | - Elena Bergamini
- Department of Movement, Human and Health Sciences, Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, University of Rome “Foro Italico”, Piazza Lauro de Bosis 15, 00135 Roma, Italy; (V.B.); or (G.V.)
- Correspondence: ; Tel.: +39-0636-733-506
| | - Marco Tramontano
- Department of Movement, Human and Health Sciences, Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, University of Rome “Foro Italico”, Piazza Lauro de Bosis 15, 00135 Roma, Italy; (V.B.); or (G.V.)
- IRCCS Santa Lucia Foundation, Via Ardeatina 306, 00179 Roma, Italy; (R.F.); (M.G.B.)
| | - Rita Formisano
- IRCCS Santa Lucia Foundation, Via Ardeatina 306, 00179 Roma, Italy; (R.F.); (M.G.B.)
| | - Maria Gabriella Buzzi
- IRCCS Santa Lucia Foundation, Via Ardeatina 306, 00179 Roma, Italy; (R.F.); (M.G.B.)
| | - Giuseppe Vannozzi
- Department of Movement, Human and Health Sciences, Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, University of Rome “Foro Italico”, Piazza Lauro de Bosis 15, 00135 Roma, Italy; (V.B.); or (G.V.)
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14
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Jimenez-Grande D, Atashzar SF, Martinez-Valdes E, De Nunzio AM, Falla D. Kinematic Biomarkers of Chronic Neck Pain During Curvilinear Walking: A Data-driven Differential Diagnosis Approach . ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:5162-5166. [PMID: 33019148 DOI: 10.1109/embc44109.2020.9176457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Chronic Neck Pain (CNP) can be associated with biomechanical changes. This paper investigates the changes in patterns of walking kinematics along a curvilinear trajectory and uses a specially designed feature space, coupled with a machine learning framework to conduct a data-driven differential diagnosis, between asymptomatic individuals and those with CNP. For this, 126 kinematic features were collected from seven body segments of 40 participants (20 asymptomatic, 20 individuals with CNP). The features space was processed through a Neighbourhood Component Analysis (NCA) algorithm to systematically select the most significant features which have the maximum discriminative power for conducting the differential diagnosis. The selected features were then processed by a K-Nearest Neighbors (K-NN) classifier to conduct the task. Our results show that, through a systematic selection of feature space, we can significantly increase the classification accuracy. In this regard, a 35% increase is reported after applying the NCA. Thus, we have shown that using only 13 features (of which 61% belong to kinematic features and 39% to statistical features) from five body segments (Head, Trunk, Pelvic, Hip and Knee) we can achieve an accuracy, sensitivity and specificity of 82.50%, 80.95% and 84.21% respectively. This promising result highlights the importance of curvilinear kinematic features through the proposed information processing pipeline for conducting differential diagnosis and could be tested in future studies to predict the likelihood of people developing recurrent neck pain.
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15
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Belluscio V, Bergamini E, Tramontano M, Orejel Bustos A, Allevi G, Formisano R, Vannozzi G, Buzzi MG. Gait Quality Assessment in Survivors from Severe Traumatic Brain Injury: An Instrumented Approach Based on Inertial Sensors. SENSORS 2019; 19:s19235315. [PMID: 31816843 PMCID: PMC6928771 DOI: 10.3390/s19235315] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 11/15/2019] [Accepted: 11/28/2019] [Indexed: 12/21/2022]
Abstract
Despite existing evidence that gait disorders are a common consequence of severe traumatic brain injury (sTBI), the literature describing gait instability in sTBI survivors is scant. Thus, the present study aims at quantifying gait patterns in sTBI through wearable inertial sensors and investigating the association of sensor-based gait quality indices with the scores of commonly administered clinical scales. Twenty healthy adults (control group, CG) and 20 people who suffered from a sTBI were recruited. The Berg balance scale, community balance and mobility scale, and dynamic gait index (DGI) were administered to sTBI participants, who were further divided into two subgroups, severe and very severe, according to their score in the DGI. Participants performed the 10 m walk, the Figure-of-8 walk, and the Fukuda stepping tests, while wearing five inertial sensors. Significant differences were found among the three groups, discriminating not only between CG and sTBI, but also for walking ability levels. Several indices displayed a significant correlation with clinical scales scores, especially in the 10 m walking and Figure-of-8 walk tests. Results show that the use of wearable sensors allows the obtainment of quantitative information about a patient’s gait disorders and discrimination between different levels of walking abilities, supporting the rehabilitative staff in designing tailored therapeutic interventions.
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Affiliation(s)
- Valeria Belluscio
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, P.zza Lauro de Bosis 15, 00135 Roma, Italy; (V.B.); (E.B.); (M.T.); (A.O.B.)
- IRCSS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Roma, Italy; (G.A.); (R.F.); (M.G.B.)
| | - Elena Bergamini
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, P.zza Lauro de Bosis 15, 00135 Roma, Italy; (V.B.); (E.B.); (M.T.); (A.O.B.)
| | - Marco Tramontano
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, P.zza Lauro de Bosis 15, 00135 Roma, Italy; (V.B.); (E.B.); (M.T.); (A.O.B.)
- IRCSS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Roma, Italy; (G.A.); (R.F.); (M.G.B.)
| | - Amaranta Orejel Bustos
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, P.zza Lauro de Bosis 15, 00135 Roma, Italy; (V.B.); (E.B.); (M.T.); (A.O.B.)
| | - Giulia Allevi
- IRCSS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Roma, Italy; (G.A.); (R.F.); (M.G.B.)
| | - Rita Formisano
- IRCSS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Roma, Italy; (G.A.); (R.F.); (M.G.B.)
| | - Giuseppe Vannozzi
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, P.zza Lauro de Bosis 15, 00135 Roma, Italy; (V.B.); (E.B.); (M.T.); (A.O.B.)
- Correspondence: ; Tel.: +39-063673-3522
| | - Maria Gabriella Buzzi
- IRCSS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Roma, Italy; (G.A.); (R.F.); (M.G.B.)
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16
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Arcolin I, Corna S, Giardini M, Giordano A, Nardone A, Godi M. Proposal of a new conceptual gait model for patients with Parkinson's disease based on factor analysis. Biomed Eng Online 2019; 18:70. [PMID: 31159825 PMCID: PMC6547597 DOI: 10.1186/s12938-019-0689-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 05/27/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Gait impairment is a risk factor for falls in patients with Parkinson's disease (PD). Gait can be conveniently assessed by electronic walkways, but there is need to select which spatiotemporal gait variables are useful for assessing gait in PD. Existing models for gait variables developed in healthy subjects and patients with PD show some methodological shortcomings in their validation through exploratory factor analysis (EFA), and were never confirmed by confirmatory factor analysis (CFA). The aims of this study were (1) to create a new model of gait for PD through EFA, (2) to analyze the factorial structure of our new model and compare it with existing models through CFA. RESULTS From the 37 variables initially considered in 250 patients with PD, 10 did not show good-to-excellent reliability and were eliminated, while further 19 were eliminated after correlation matrix and Kaiser-Meyer-Olkin measure. The remaining eight variables underwent EFA and three factors emerged: pace/rhythm, variability, and asymmetry. Structural validity of our new model was then examined with CFA, using the structural equation modeling. After some modifications, suggested by the Modification Indices, we obtained a final model that showed an excellent fit. In contrast, when the structure of previous models of gait was analyzed, no model achieved convergence with our sample of patients. CONCLUSIONS Our model for spatiotemporal gait variables of patients with PD is the first to be developed through an accurate EFA and confirmed by CFA. It contains eight gait variables divided into three factors and shows an excellent fit. Reasons for the non-convergence of other models could be their inclusion of highly inter-correlated or low-reliability variables or could be possibly due to the fact that they did not use more recent methods for determining the number of factors to extract.
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Affiliation(s)
- Ilaria Arcolin
- Istituti Clinici Scientifici Maugeri Spa SB (IRCCS), Pavia, Italy
| | - Stefano Corna
- Istituti Clinici Scientifici Maugeri Spa SB (IRCCS), Pavia, Italy
| | - Marica Giardini
- Istituti Clinici Scientifici Maugeri Spa SB (IRCCS), Pavia, Italy
| | - Andrea Giordano
- Istituti Clinici Scientifici Maugeri Spa SB (IRCCS), Pavia, Italy
| | - Antonio Nardone
- Istituti Clinici Scientifici Maugeri Spa SB (IRCCS), Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Marco Godi
- Istituti Clinici Scientifici Maugeri Spa SB (IRCCS), Pavia, Italy
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17
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Godi M, Giardini M, Schieppati M. Walking Along Curved Trajectories. Changes With Age and Parkinson's Disease. Hints to Rehabilitation. Front Neurol 2019; 10:532. [PMID: 31178816 PMCID: PMC6543918 DOI: 10.3389/fneur.2019.00532] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/03/2019] [Indexed: 01/11/2023] Open
Abstract
In this review, we briefly recall the fundamental processes allowing us to change locomotion trajectory and keep walking along a curved path and provide a review of contemporary literature on turning in older adults and people with Parkinson's Disease (PD). The first part briefly summarizes the way the body exploits the physical laws to produce a curved walking trajectory. Then, the changes in muscle and brain activation underpinning this task, and the promoting role of proprioception, are briefly considered. Another section is devoted to the gait changes occurring in curved walking and steering with aging. Further, freezing during turning and rehabilitation of curved walking in patients with PD is mentioned in the last part. Obviously, as the research on body steering while walking or turning has boomed in the last 10 years, the relevant critical issues have been tackled and ways to improve this locomotor task proposed. Rationale and evidences for successful training procedures are available, to potentially reduce the risk of falling in both older adults and patients with PD. A better understanding of the pathophysiology of steering, of the subtle but vital interaction between posture, balance, and progression along non-linear trajectories, and of the residual motor learning capacities in these cohorts may provide solid bases for new rehabilitative approaches.
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Affiliation(s)
- Marco Godi
- Division of Physical Medicine and Rehabilitation, ICS Maugeri SPA SB, Pavia, Italy
| | - Marica Giardini
- Division of Physical Medicine and Rehabilitation, ICS Maugeri SPA SB, Pavia, Italy
| | - Marco Schieppati
- Department of Exercise and Sport Science, International University of Health, Exercise and Sports, LUNEX University, Differdange, Luxembourg
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18
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Which Gait Parameters and Walking Patterns Show the Significant Differences Between Parkinson's Disease and Healthy Participants? BIOSENSORS-BASEL 2019; 9:bios9020059. [PMID: 31027153 PMCID: PMC6627461 DOI: 10.3390/bios9020059] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 04/16/2019] [Accepted: 04/22/2019] [Indexed: 02/08/2023]
Abstract
This study investigated the difference in the gait of patients with Parkinson’s disease (PD), age-matched controls and young controls during three walking patterns. Experiments were conducted with 24 PD, 24 age-matched controls and 24 young controls, and four gait intervals were measured using inertial measurement units (IMU). Group differences between the mean and variance of the gait parameters (stride interval, stance interval, swing interval and double support interval) for the three groups were calculated and statistical significance was tested. The results showed that the variance in each of the four gait parameters of PD patients was significantly higher compared with the controls, irrespective of the three walking patterns. This study showed that the variance of any of the gait interval parameters obtained using IMU during any of the walking patterns could be used to differentiate between the gait of PD and control people.
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Podokinetic After-Rotation Is Transiently Enhanced or Reversed by Unilateral Axial Muscle Proprioceptive Stimulation. Neural Plast 2019; 2019:7129279. [PMID: 30984256 PMCID: PMC6432728 DOI: 10.1155/2019/7129279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/11/2018] [Indexed: 12/25/2022] Open
Abstract
Unilateral axial muscle vibration, eliciting a proprioceptive volley, is known to incite steering behavior. Whole-body rotation while stepping in place also occurs as an after-effect of stepping on a circular treadmill (podokinetic after-rotation, PKAR). Here, we tested the hypothesis that PKAR is modulated by axial muscle vibration. If both phenomena operate through a common pathway, enhancement or cancellation of body rotation would occur depending on the stimulated side when vibration is administered concurrently with PKAR. Seventeen subjects participated in the study. In one session, subjects stepped in place eyes open on the center of a platform that rotated counterclockwise 60°/s for 10 min. When the platform stopped, subjects continued stepping in place blindfolded. In other session, a vibratory stimulus (100 Hz, 2 min) was administered to right or left paravertebral muscles at lumbar level at two intervals during the PKAR. We computed angular body velocity and foot step angles from markers fixed to shoulders and feet. During PKAR, all subjects rotated clockwise. Decreased angular velocity was induced by right vibration. Conversely, when vibration was administered to the left, clockwise rotation velocity increased. The combined effect on body rotation depended on the time at which vibration was administered during PKAR. Under all conditions, foot step angle was coherent with shoulder angular velocity. PKAR results from continuous asymmetric input from the muscles producing leg rotation, while axial muscle vibration elicits a proprioceptive asymmetric input. Both conditioning procedures appear to produce their effects through a common mechanism. We suggest that both stimulations would affect our straight ahead by combining their effects in an algebraic mode.
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