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Zhang Y, Zhang C, Wang X, Liu Y, Jin Z, Haacke EM, He N, Li D, Yan F. Iron and neuromelanin imaging in basal ganglia circuitry in Parkinson's disease with freezing of gait. Magn Reson Imaging 2024; 111:229-236. [PMID: 38777243 DOI: 10.1016/j.mri.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 05/18/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE This study aimed to examine the structural alterations of the deep gray matter (DGM) in the basal ganglia circuitry of Parkinson's disease (PD) patients with freezing of gait (FOG) using quantitative susceptibility mapping (QSM) and neuromelanin-sensitive magnetic resonance imaging (NM-MRI). METHODS Twenty-five (25) PD patients with FOG (PD-FOG), 22 PD patients without FOG (PD-nFOG), and 30 age- and sex-matched healthy controls (HCs) underwent 3-dimensional multi-echo gradient recalled echo and NM-MRI scanning. The mean volume and susceptibility of the DGM on QSM data and the relative contrast (NMRC-SNpc) and volume (NMvolume-SNpc) of the substantia nigra pars compacta on NM-MRI were analyzed among groups. A multiple linear regression analysis was performed to explore the associations of FOG severity with MRI measurements and disease stage. RESULTS The PD-FOG group showed higher susceptibility in the bilateral caudal substantia nigra (SN) compared to the HC group. Both the PD-FOG and PD-nFOG groups showed lower volumes than the HC group in the bilateral caudate and putamen as determined from the QSM data. The NMvolume-SNpc on NM-MRI in the PD-FOG group was significantly lower than in the HC and PD-nFOG groups. Both the PD-FOG and PD-nFOG groups showed significantly decreased NMRC-SNpc. CONCLUSIONS The PD-FOG patients showed abnormal neostriatum atrophy, increases in iron deposition in the SN, and lower NMvolume-SNpc. The structural alterations of the DGM in the basal ganglia circuits could lead to the abnormal output of the basal ganglia circuit to trigger the FOG in PD patients.
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Affiliation(s)
- Youmin Zhang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chencheng Zhang
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinhui Wang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Liu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhijia Jin
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - E Mark Haacke
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Radiology, Wayne State University, Detroit, MI, USA
| | - Naying He
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Dianyou Li
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Beausoleil NJ, Farouk MM, Webster J, Johnson CB, Dowling S, Sazili AQ, Cameron C. Comparison of recovery of sheep, goats, and calves from reversible electrical head-only and head-to-body stunning for halal meat production. N Z Vet J 2024; 72:288-299. [PMID: 38946044 DOI: 10.1080/00480169.2024.2367532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/28/2024] [Indexed: 07/02/2024]
Abstract
AIMS To compare the recovery of lambs, goats, and calves from head-only (HO) or high-frequency head-to-body stunning and evaluate the complementary use of behaviour and electroencephalography (EEG) to assess return to consciousness after electrical stunning in these species. METHODS Six-month-old lambs, adult goats and calves (< 7 days old) were subjected to reversible head-only stunning (50 Hz, 1 A, 2 seconds) or reversible high-frequency head-to-body stunning (RHTB: HO followed by 2,000 Hz, 2 A, 4-second stun to body). Following stunning, behavioural recovery was assessed in 21 lambs, 22 goats, and 20 calves. Latencies to first perform behaviours (end of convulsions, head lift, attempt to right, successful righting, attempt to stand, successful standing) after stunning were scored from video recordings. Recovery of electrical brain activity indicative of consciousness was assessed using EEG in a separate cohort of minimally-anaesthetised lambs, goats and calves (n = 20 per species). EEG traces collected before and after stunning were classified as normal, epileptiform, isoelectric, or transitional activity. Following stunning, the duration of epileptiform and isoelectric activity combined (states of brain activity incompatible with conscious awareness) was calculated, as was latency to return of normal (pre-stun) EEG. RESULTS The RHTB stun was reversible in all three species, although one sheep failed to recover and was euthanised. Both methods caused tonic and clonic convulsions in all species. Behavioural recovery of sheep and calves was similar for both methods while goats took longer to recover from RHTB than HO stunning. There was no evidence of differences between methods in the duration of EEG incompatible with consciousness or the latency to recovery of normal EEG. CONCLUSIONS Head-to-body stunning as applied here produced a reversible electrical stun in lambs, adult goats and young calves, although the benefits in terms of meat quality and operator safety are uncertain. Goats took longer to recover behaviourally from head-to-body stunning, possibly due to disrupted motor function, but there was no indication that post-stun unconsciousness lasted longer than following head-only stunning in any species. The normal behaviour for the animals' developmental age should be considered when deciding on behavioural indicators of recovery. The minimal anaesthesia model provided excellent quality EEG data that was valuable for interpretation of the behavioural responses. CLINICAL RELEVANCE For the purposes of pre-slaughter stunning of sheep, goats and young calves, recovery appears comparable between the two methods, with all but 1/63 animals in the behaviour study recovering normal function.
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Affiliation(s)
- N J Beausoleil
- Animal Welfare Science and Bioethics Centre, Tāwharau Ora - School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - M M Farouk
- AgResearch Ltd., Ruakura Research Centre, Hamilton, New Zealand
| | - J Webster
- AgResearch Ltd., Ruakura Research Centre, Hamilton, New Zealand
| | - C B Johnson
- Animal Welfare Science and Bioethics Centre, Tāwharau Ora - School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - S Dowling
- AgResearch Ltd., Ruakura Research Centre, Hamilton, New Zealand
| | - A Q Sazili
- Halal Products Research Institute, Universiti Putra Malaysia, Serdang, Malaysia
| | - C Cameron
- AgResearch Ltd., Ruakura Research Centre, Hamilton, New Zealand
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da Silva Costa AA, Moraes R, den Otter R, Gennaro F, Bakker L, Rocha Dos Santos PC, Hortobágyi T. Corticomuscular and intermuscular coherence as a function of age and walking balance difficulty. Neurobiol Aging 2024; 141:85-101. [PMID: 38850592 DOI: 10.1016/j.neurobiolaging.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 04/12/2024] [Accepted: 05/08/2024] [Indexed: 06/10/2024]
Abstract
We determined beta-band intermuscular (IMC) and corticomuscular coherence (CMC) as a function of age and walking balance difficulty. Younger (n=14, 23y) and older individuals (n=19, 71y) walked 13 m overground, on a 6-cm-wide ribbon overground, and on a 6-cm-wide (5-cm-high) beam. Walking distance as a proxy for walking balance and speed were computed. CMC was estimated between electroencephalographic signal at Cz electrode and surface electromyographic signals of seven leg muscles, while IMC was calculated in four pairs of leg muscles, during stance and swing gait phases. With increasing difficulty, walking balance decreased in old individuals and speed decreased gradually independent of age. Beam walking increased IMC, while age increased IMC in proximal muscle pairs, and decreased IMC in distal muscle pairs. Age and difficulty increased CMC independent of gait phases. Concluding, CMC and IMC increased with walking balance difficulty and age, except for distal muscle pairs, which had lower IMC with age. These findings suggest an age-related increase in corticospinal involvement in the neural control of walking balance. DATA AVAILABILITY: The datasets used in this study are available from the corresponding author upon reasonable request.
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Affiliation(s)
- Andréia Abud da Silva Costa
- Ribeirão Preto Medical School, Graduate Program in Rehabilitation and Functional Performance, University of São Paulo, Brazil; Biomechanics and Motor Control Lab, School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Brazil; Department of Human Movement Sciences, University of Groningen Medical Center, Groningen, the Netherlands.
| | - Renato Moraes
- Ribeirão Preto Medical School, Graduate Program in Rehabilitation and Functional Performance, University of São Paulo, Brazil; Biomechanics and Motor Control Lab, School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Brazil
| | - Rob den Otter
- Department of Human Movement Sciences, University of Groningen Medical Center, Groningen, the Netherlands
| | - Federico Gennaro
- Department of Biomedical Sciences, University of Padua, Padua, Italy
| | - Lisanne Bakker
- Department of Human Movement Sciences, University of Groningen Medical Center, Groningen, the Netherlands
| | - Paulo Cezar Rocha Dos Santos
- Department of Computer Science & Applied Mathematics, Weizmann Institute of Science, Israel; The Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Israel; IDOR/Pioneer Science Initiative, Rio de Janeiro, RJ, Brazil
| | - Tibor Hortobágyi
- Department of Human Movement Sciences, University of Groningen Medical Center, Groningen, the Netherlands; Department of Kinesiology, Hungarian University of Sports Science, Budapest 1123, Hungary; Department of Sport Biology, Institute of Sport Sciences and Physical Education, University of Pécs, Pécs, Hungary
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Pellegrini F, Pozzi NG, Palmisano C, Marotta G, Buck A, Haufe S, Isaias IU. Cortical networks of parkinsonian gait: a metabolic and functional connectivity study. Ann Clin Transl Neurol 2024. [PMID: 39186320 DOI: 10.1002/acn3.52173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 06/03/2024] [Accepted: 07/08/2024] [Indexed: 08/27/2024] Open
Abstract
OBJECTIVE Locomotion is an automated voluntary movement sustained by coordinated neural synchronization across a distributed brain network. The cerebral cortex is central for adapting the locomotion pattern to the environment and alterations of cortical network dynamics can lead to gait impairments. Gait problems are a common symptom with a still unclear pathophysiology and represent an unmet therapeutical need in Parkinson's disease. Little is known about the cortical network dynamics of locomotor control in these patients. METHODS We studied the cortical basis of parkinsonian gait by combining metabolic brain imaging with high-density EEG recordings and kinematic measurements performed at rest and during unperturbed overground walking. RESULTS We found significant changes in functional connectivity between frontal, sensorimotor, and visuomotor cortical areas during walking as compared to resting. Specifically, hypokinetic gait was associated with poor information flow from the supplementary motor area (SMA) to precuneus and from calcarine to lingual gyrus, as well as high information flow from calcarine to cuneus. INTERPRETATION Our findings support a role for visuomotor integration processes in PD-related hypokinetic gait and suggest that reinforcing visual information may act as a compensatory strategy to allow SMA-mediated feedforward locomotor control in PD.
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Affiliation(s)
- Franziska Pellegrini
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin Center for Advanced Neuroimaging (BCAN), Berlin, Germany
- Bernstein Center for Computational Neuroscience, Berlin, Germany
| | - Nicoló G Pozzi
- Department of Neurology, University Hospital of Würzburg and The Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Chiara Palmisano
- Department of Neurology, University Hospital of Würzburg and The Julius Maximilian University of Würzburg, Würzburg, Germany
- Parkinson Institute of Milan, ASST G. Pini-CTO, Milano, Italy
| | - Giorgio Marotta
- Department of Nuclear Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Andreas Buck
- Department of Nuclear Medicine, University Hospital of Würzburg, Würzburg, Germany
| | - Stefan Haufe
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin Center for Advanced Neuroimaging (BCAN), Berlin, Germany
- Bernstein Center for Computational Neuroscience, Berlin, Germany
- Uncertainty, Inverse Modeling and Machine Learning Group, Faculty IV Electrical Engineering and Computer Science, Technische Universität Berlin, Berlin, Germany
- Physikalisch-Technische Bundesanstalt Braunschweig und Berlin, Berlin, Germany
| | - Ioannis U Isaias
- Department of Neurology, University Hospital of Würzburg and The Julius Maximilian University of Würzburg, Würzburg, Germany
- Parkinson Institute of Milan, ASST G. Pini-CTO, Milano, Italy
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Nogueira F, Shirahige L, Brito R, Lima H, Victor J, Sanchez MP, Ilha J, Monte-Silva K. Repetitive Transcranial Magnetic Stimulation with Body Weight-supported Treadmill Training Enhances Independent Walking of Individuals with Chronic Incomplete Spinal Cord Injury: A Pilot Randomized Clinical Trial. Brain Topogr 2024:10.1007/s10548-024-01072-0. [PMID: 39162868 DOI: 10.1007/s10548-024-01072-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 07/22/2024] [Indexed: 08/21/2024]
Abstract
The purpose of this study is to evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) combined with body weight-support treadmill training (BWSTT) for improving walking function of individuals with chronic incomplete spinal cord injury (iSCI). A 4-week, double-blinded, randomized, sham-controlled pilot study involved 12 sessions of real (10 Hz, 1800 pulses) or sham rTMS combined with BWSTT (15-20 min, moderate intensity). Walking independence was assessed using the Walking Index for Spinal Cord Injury II (WISCI-II). Lower extremity motor function (lower extremity motor score [LEMS]) and spasticity, sensory function, functional independence (Spinal Cord Injury Measure III [SCIM-III]), and quality of life were also assessed. Walking independence (WISCI-II) after the 6th session was higher in the BWSTT/rTMS real (n = 7) (median change (IQR): 3 (1.5 to 3.5)) than in the sham group (n = 8) (median change (IQR): 0 (0 to 0.25), but there was no difference between groups after 12th session (BWSTT/rTMS real median change (IQR): 4 (2 to 5); BWSSTT/rTMS sham median change (IQR): 0 (0 to 3.25). Compared to baseline, LEMS and SCIM-III mobility scores were increased after 12 sessions in the BWSTT/rTMS real but not in the sham group. Within- and between-group sensory function, functional independence, and quality of life remained similar. This preliminary result suggests that combining BWSTT with rTMS could lead to earlier gait improvement in patients with chronic iSCI.
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Affiliation(s)
- Fernanda Nogueira
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Av. Jornalista Aníbal Fernandes, 173-, Recife, CEP 50670-901, Pernambuco, Brazil
| | - Lívia Shirahige
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Av. Jornalista Aníbal Fernandes, 173-, Recife, CEP 50670-901, Pernambuco, Brazil
| | - Rodrigo Brito
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Av. Jornalista Aníbal Fernandes, 173-, Recife, CEP 50670-901, Pernambuco, Brazil
| | - Hamably Lima
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Av. Jornalista Aníbal Fernandes, 173-, Recife, CEP 50670-901, Pernambuco, Brazil
| | - João Victor
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Av. Jornalista Aníbal Fernandes, 173-, Recife, CEP 50670-901, Pernambuco, Brazil
| | - María Paz Sanchez
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Av. Jornalista Aníbal Fernandes, 173-, Recife, CEP 50670-901, Pernambuco, Brazil
| | - Jocemar Ilha
- Department of Fisioterapia, Universidade do Estado de Santa Catarina, Rua Pascoal Simone, 358, Florianópolis, CEP 88080-350, SC, Brazil
| | - Katia Monte-Silva
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Av. Jornalista Aníbal Fernandes, 173-, Recife, CEP 50670-901, Pernambuco, Brazil.
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Sato Y, Terasawa Y, Okada Y, Hasui N, Mizuta N, Ohnishi S, Fujita D, Morioka S. Effects of cerebellar transcranial direct current stimulation on the excitability of spinal motor neurons and vestibulospinal tract in healthy individuals. Exp Brain Res 2024:10.1007/s00221-024-06894-9. [PMID: 39133291 DOI: 10.1007/s00221-024-06894-9] [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: 04/12/2024] [Accepted: 07/05/2024] [Indexed: 08/13/2024]
Abstract
Cerebellar transcranial direct current stimulation (ctDCS) modulates cerebellar cortical excitability in a polarity-dependent manner and affects inhibitory pathways from the cerebellum. The cerebellum modulates spinal reflex excitability via the vestibulospinal tract and other pathways projecting to the spinal motor neurons; however, the effects of ctDCS on the excitability of spinal motor neurons and vestibulospinal tract remain unclear. The experiment involved 13 healthy individuals. ctDCS (sham-ctDCS, anodal-ctDCS, and cathodal-ctDCS) was applied to the cerebellar vermis at 2 mA with an interval of at least 3 days between each condition. We measured the maximal M-wave (Mmax) and maximal H-reflex (Hmax) in the right soleus muscle to assess the excitability of spinal motor neurons. We applied galvanic vestibular stimulation (GVS) for 200 ms at 100 ms before tibial nerve stimulation to measure Hmax conditioned by GVS (GVS-Hmax) and calculated the change rate of Hmax by GVS as the excitability of vestibulospinal tract. We measured the Mmax, Hmax, and GVS-Hmax before, during, and after ctDCS in the sitting posture. No main effects of tDCS condition, main effects of time, or interaction effects were observed in Hmax/Mmax or the change rate of Hmax by GVS. It has been suggested that ctDCS does not affect the excitability of spinal motor neurons and vestibulospinal tract, as measured by neurophysiological methods, such as the H-reflex, in healthy individuals in a sitting posture. Effect of ctDCS on other descending pathways to spinal motor neurons, the neurological mechanism of tDCS and the cerebellar activity during the experiment may have contributed to these results. Therefore, we need to investigate the involvement of the cerebellum in Hmax/Mmax and the change rate of Hmax by GVS under different neuromodulation techniques and postural conditions.
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Affiliation(s)
- Yuki Sato
- Department of Neurorehabilitation Laboratory, Graduate School of Health Sciences, Kio University, 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun, Nara, 635-0832, Japan.
- Department of Therapy, Takarazuka Rehabilitation Hospital, Medical Corporation SHOWAKAI, 22-2 Tsurunoso, Takarazuka-shi, Hyogo, 665-0833, Japan.
| | - Yuta Terasawa
- Department of Neurorehabilitation Laboratory, Graduate School of Health Sciences, Kio University, 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun, Nara, 635-0832, Japan
| | - Yohei Okada
- Department of Neurorehabilitation Laboratory, Graduate School of Health Sciences, Kio University, 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun, Nara, 635-0832, Japan
- Neurorehabilitation Research Center, Kio University, 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun, Nara, 635-0832, Japan
| | - Naruhito Hasui
- Department of Neurorehabilitation Laboratory, Graduate School of Health Sciences, Kio University, 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun, Nara, 635-0832, Japan
- Department of Therapy, Takarazuka Rehabilitation Hospital, Medical Corporation SHOWAKAI, 22-2 Tsurunoso, Takarazuka-shi, Hyogo, 665-0833, Japan
| | - Naomichi Mizuta
- Department of Rehabilitation, Faculty of Health Sciences, Nihon Fukushi University, 26-2 Higashihaemi-cho, Handa-shi, Aichi, 475-0012, Japan
- Neurorehabilitation Research Center, Kio University, 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun, Nara, 635-0832, Japan
| | - Sora Ohnishi
- Department of Neurorehabilitation Laboratory, Graduate School of Health Sciences, Kio University, 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun, Nara, 635-0832, Japan
- Department of Therapy, Takarazuka Rehabilitation Hospital, Medical Corporation SHOWAKAI, 22-2 Tsurunoso, Takarazuka-shi, Hyogo, 665-0833, Japan
| | - Daiki Fujita
- Department of Neurorehabilitation Laboratory, Graduate School of Health Sciences, Kio University, 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun, Nara, 635-0832, Japan
| | - Shu Morioka
- Department of Neurorehabilitation Laboratory, Graduate School of Health Sciences, Kio University, 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun, Nara, 635-0832, Japan
- Neurorehabilitation Research Center, Kio University, 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun, Nara, 635-0832, Japan
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Li Y, Li J, Wang P, Yu D, Chen Z, Shi Z, Wu Y, Qi W, Lu W, Shi H. Electroencephalography microstate alterations reflect potential double-edged cognitive adaptation in Ménière's disease. CNS Neurosci Ther 2024; 30:e14896. [PMID: 39107944 PMCID: PMC11303265 DOI: 10.1111/cns.14896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 07/11/2024] [Accepted: 07/19/2024] [Indexed: 08/10/2024] Open
Abstract
PURPOSE To explore the microstate characteristics and underlying brain network activity of Ménière's disease (MD) patients based on high-density electroencephalography (EEG), elucidate the association between microstate dynamics and clinical manifestation, and explore the potential of EEG microstate features as future neurobiomarkers for MD. METHODS Thirty-two patients diagnosed with MD and 29 healthy controls (HC) matched for demographic characteristics were included in the study. Dysfunction and subjective symptom severity were assessed by neuropsychological questionnaires, pure tone audiometry, and vestibular function tests. Resting-state EEG recordings were obtained using a 256-channel EEG system, and the electric field topographies were clustered into four dominant microstate classes (A, B, C, and D). The dynamic parameters of each microstate were analyzed and utilized as input for a support vector machine (SVM) classifier to identify significant microstate signatures associated with MD. The clinical significance was further explored through Spearman correlation analysis. RESULTS MD patients exhibited an increased presence of microstate class C and a decreased frequency of transitions between microstate class A and B, as well as between class A and D. The transitions from microstate class A to C were also elevated. Further analysis revealed a positive correlation between equilibrium scores and the transitions from microstate class A to C under somatosensory challenging conditions. Conversely, transitions between class A and B were negatively correlated with vertigo symptoms. No significant correlations were detected between these characteristics and auditory test results or emotional scores. Utilizing the microstate features identified via sequential backward selection, the linear SVM classifier achieved a sensitivity of 86.21% and a specificity of 90.61% in distinguishing MD patients from HC. CONCLUSIONS We identified several EEG microstate characteristics in MD patients that facilitate postural control yet exacerbate subjective symptoms, and effectively discriminate MD from HC. The microstate features may offer a new approach for optimizing cognitive compensation strategies and exploring potential neurobiological markers in MD.
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Affiliation(s)
- Yi‐Ni Li
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Jie Li
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Peng‐Jun Wang
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Dong‐Zhen Yu
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Zheng‐Nong Chen
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Zheng‐Yu Shi
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Ya‐Qin Wu
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Wei‐Dong Qi
- Department of Otolaryngology Head and Neck SurgeryHuashan Hospital Fudan UniversityShanghaiChina
| | - Wen Lu
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Hai‐Bo Shi
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
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Heng JG, Zhang J, Bonetti L, Lim WPH, Vuust P, Agres K, Chen SHA. Understanding music and aging through the lens of Bayesian inference. Neurosci Biobehav Rev 2024; 163:105768. [PMID: 38908730 DOI: 10.1016/j.neubiorev.2024.105768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 06/05/2024] [Accepted: 06/10/2024] [Indexed: 06/24/2024]
Abstract
Bayesian inference has recently gained momentum in explaining music perception and aging. A fundamental mechanism underlying Bayesian inference is the notion of prediction. This framework could explain how predictions pertaining to musical (melodic, rhythmic, harmonic) structures engender action, emotion, and learning, expanding related concepts of music research, such as musical expectancies, groove, pleasure, and tension. Moreover, a Bayesian perspective of music perception may shed new insights on the beneficial effects of music in aging. Aging could be framed as an optimization process of Bayesian inference. As predictive inferences refine over time, the reliance on consolidated priors increases, while the updating of prior models through Bayesian inference attenuates. This may affect the ability of older adults to estimate uncertainties in their environment, limiting their cognitive and behavioral repertoire. With Bayesian inference as an overarching framework, this review synthesizes the literature on predictive inferences in music and aging, and details how music could be a promising tool in preventive and rehabilitative interventions for older adults through the lens of Bayesian inference.
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Affiliation(s)
- Jiamin Gladys Heng
- School of Computer Science and Engineering, Nanyang Technological University, Singapore.
| | - Jiayi Zhang
- Interdisciplinary Graduate Program, Nanyang Technological University, Singapore; School of Social Sciences, Nanyang Technological University, Singapore; Centre for Research and Development in Learning, Nanyang Technological University, Singapore
| | - Leonardo Bonetti
- Center for Music in the Brain, Department of Clinical Medicine, Aarhus University & The Royal Academy of Music, Aarhus, Aalborg, Denmark; Centre for Eudaimonia and Human Flourishing, Linacre College, University of Oxford, United Kingdom; Department of Psychiatry, University of Oxford, United Kingdom; Department of Psychology, University of Bologna, Italy
| | | | - Peter Vuust
- Center for Music in the Brain, Department of Clinical Medicine, Aarhus University & The Royal Academy of Music, Aarhus, Aalborg, Denmark
| | - Kat Agres
- Centre for Music and Health, National University of Singapore, Singapore; Yong Siew Toh Conservatory of Music, National University of Singapore, Singapore
| | - Shen-Hsing Annabel Chen
- School of Social Sciences, Nanyang Technological University, Singapore; Centre for Research and Development in Learning, Nanyang Technological University, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; National Institute of Education, Nanyang Technological University, Singapore.
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Sato Y, Hasui N, Mizuta N, Ohnishi S, Okada Y, Nakatani T, Taguchi J, Morioka S. Effects of Anodal tDCS Applied Over the Cerebellum Combined with Physical Therapy on Center of Gravity Sway in a Patient with Cerebellar Ataxia: A Single-Case Study. CEREBELLUM (LONDON, ENGLAND) 2024:10.1007/s12311-024-01719-5. [PMID: 39052146 DOI: 10.1007/s12311-024-01719-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/04/2024] [Indexed: 07/27/2024]
Abstract
Damage to the cerebellum results in dysfunctional standing postural control. Patients with cerebellar ataxia have a larger sway in the center of gravity (COG) while standing. Transcranial direct current stimulation (tDCS) has been applied in the rehabilitation of patients with central nervous system disorders; however, its effect on COG sway in patients with cerebellar ataxia remains unknown. We aimed to confirm the effects of anodal cerebellar tDCS (ctDCS) combined with physical therapy on COG sway in a patient with cerebellar ataxia using a retrospective ABA single-case study design. This study involved a patient with left cerebellar hemorrhage. Walking and postural balance rehabilitation were conducted in phase A. Anodal ctDCS was combined with the walking and postural balance rehabilitation in phase B. We measured COG sway in the open- and closed-eyes standing conditions daily throughout all the phases. In the open-eyes standing condition, there was no significant change in COG sway in phase B. Conversely, in the closed-eyes standing condition, the circumferential area, total sway path length, and anteroposterior sway path length decreased in phase B. No change was observed in the mediolateral sway path length. The combination of anodal ctDCS and physical therapy may decrease COG sway in patients with cerebellar ataxia in the closed-eyes standing condition, and its effect may be greater in the anteroposterior direction.
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Affiliation(s)
- Yuki Sato
- Department of Neurorehabilitation Laboratory, Graduate School of Health Sciences, Kio University, 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun, Nara, 635-0832, Japan.
- Department of Therapy, Takarazuka Rehabilitation Hospital, Medical Corporation SHOWAKAI, 22-2 Tsurunoso, Takarazuka-shi, Hyogo, 665-0833, Japan.
| | - Naruhito Hasui
- Department of Neurorehabilitation Laboratory, Graduate School of Health Sciences, Kio University, 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun, Nara, 635-0832, Japan
- Department of Therapy, Takarazuka Rehabilitation Hospital, Medical Corporation SHOWAKAI, 22-2 Tsurunoso, Takarazuka-shi, Hyogo, 665-0833, Japan
| | - Naomichi Mizuta
- Department of Rehabilitation, Faculty of Health Sciences, Nihon Fukushi University, 26-2 Higashihaemi-cho, Handa-shi, Aichi, 475-0012, Japan
- Neurorehabilitation Research Center, Kio University, 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun, Nara, 635-0832, Japan
| | - Sora Ohnishi
- Department of Neurorehabilitation Laboratory, Graduate School of Health Sciences, Kio University, 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun, Nara, 635-0832, Japan
- Department of Therapy, Takarazuka Rehabilitation Hospital, Medical Corporation SHOWAKAI, 22-2 Tsurunoso, Takarazuka-shi, Hyogo, 665-0833, Japan
| | - Yohei Okada
- Department of Neurorehabilitation Laboratory, Graduate School of Health Sciences, Kio University, 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun, Nara, 635-0832, Japan
- Neurorehabilitation Research Center, Kio University, 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun, Nara, 635-0832, Japan
| | - Tomoki Nakatani
- Department of Therapy, Takarazuka Rehabilitation Hospital, Medical Corporation SHOWAKAI, 22-2 Tsurunoso, Takarazuka-shi, Hyogo, 665-0833, Japan
| | - Junji Taguchi
- Department of Therapy, Takarazuka Rehabilitation Hospital, Medical Corporation SHOWAKAI, 22-2 Tsurunoso, Takarazuka-shi, Hyogo, 665-0833, Japan
| | - Shu Morioka
- Department of Neurorehabilitation Laboratory, Graduate School of Health Sciences, Kio University, 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun, Nara, 635-0832, Japan
- Neurorehabilitation Research Center, Kio University, 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun, Nara, 635-0832, Japan
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Mikami K, Kamo T, Ichinoseki-Sekine N. Sex-related differences in the posture and vertical perception of gait function in patients with Parkinson's disease. Gait Posture 2024; 113:324-329. [PMID: 39024985 DOI: 10.1016/j.gaitpost.2024.07.006] [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: 04/24/2024] [Revised: 07/04/2024] [Accepted: 07/07/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Although several factors, such as sex and body schema, contribute to gait function, factors for gait dysfunction in Parkinson's disease (PD) have not been elucidated. Postural verticality, a higher-order neural mechanism of gait, is involved in generation of a gait program in healthy individuals; however, its role in patients with PD is unclear. Although subjective postural vertical (SPV), which denotes cognitive information about posture with verticality as the reference axis, is anteriorly and laterally shifted in patients with PD, the presence of sex-related differences in SPV and effect of SPV on gait function remain unclear. Since SPV affects the degree of flexion and lateral bending posture and long-term prognosis of PD, factors affecting SPV in patients with PD should be clarified to improve gait function. RESEARCH QUESTION Is vertical perception of posture (i.e., SPV) related to gait function in patients with PD? Are there any sex-related differences? METHODS The gait and SPV were evaluated in 59 adult outpatients with PD (31 men and 28 women) using five gait (step length, walking speed, coefficient of variation of step time [step CV], cadence, and mean gait acceleration [acceleration]) and two SPV (SPV in the sagittal and coronal planes) assessments and compared between the sexes. RESULTS No sex-related differences were observed in the SPV in patients with PD. The SPV and gait assessments demonstrated no association in men. Walking speed and SPV in the sagittal plane (p = 0.029), and step CV and SPV in the coronal (p = 0.018) and sagittal planes (p = 0.032) were correlated in women. SIGNIFICANCE Although no sex-related differences in the SPV were observed, our results demonstrated that the SPV is involved in gait function in women but not in men with PD.
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Affiliation(s)
- Kyohei Mikami
- Department of Rehabilitation, Noborito Neurology Clinic, Kawasaki, Japan; Graduate School of Arts and Sciences, The Open University of Japan, Chiba, Japan.
| | - Tsutomu Kamo
- Department of Neurology, Noborito Neurology Clinic, Kawasaki, Japan
| | - Noriko Ichinoseki-Sekine
- Graduate School of Arts and Sciences, The Open University of Japan, Chiba, Japan; School of Health and Sports Science, Juntendo University, Inzai, Japan
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11
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Mallo-López A, Cuesta-Gómez A, Fernández-Pardo TE, Aguilera-Rubio Á, Molina-Rueda F. Influence of Impaired Upper Extremity Motor Function on Static Balance in People with Chronic Stroke. SENSORS (BASEL, SWITZERLAND) 2024; 24:4311. [PMID: 39001091 PMCID: PMC11244378 DOI: 10.3390/s24134311] [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: 06/04/2024] [Revised: 06/21/2024] [Accepted: 07/01/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Stroke is a leading cause of disability, especially due to an increased fall risk and postural instability. The objective of this study was to analyze the impact of motor impairment in the hemiparetic UE on static balance in standing, in subject with chronic stroke. METHODS Seventy adults with chronic stroke, capable of independent standing and walking, participated in this cross-sectional study. The exclusion criteria included vestibular, cerebellar, or posterior cord lesions. The participants were classified based on their UE impairment using the Fugl-Meyer Assessment of Motor Recovery after Stroke (FMA-UE). A posturographic evaluation (mCTSIB) was performed in the standing position to analyze the center of pressure (COP) displacement in the mediolateral (ML) and anteroposterior (AP) axes and its mean speed with eyes open (OE) and closed (EC) on stable and unstable surfaces. RESULTS A strong and significant correlation (r = -0.53; p < 0.001) was observed between the mediolateral (ML) center of pressure (COP) oscillation and the FMA-UE, which was particularly strong with eyes closed [r(EO) = 0.5; r(EC) = 0.54]. The results of the multiple linear regression analysis indicated that the ML oscillation is influenced significantly by the FMA-Motor, and specifically by the sections on UE, wrist, coordination/speed, and sensation. CONCLUSIONS The hemiparetic UE motor capacity is strongly related to the ML COP oscillation during standing in individuals with chronic stroke, with a lower motor capacity associated with a greater instability. Understanding these relationships underpins the interventions to improve balance and reduce falls in people who have had a stroke.
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Affiliation(s)
- Ana Mallo-López
- International Doctorate School, Rey Juan Carlos University, 28933 Madrid, Spain
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain;
| | - Alicia Cuesta-Gómez
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain
- Motion Analysis, Ergonomics, Biomechanics and Motor Control Laboratory (LAMBECOM), Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain
| | - Teresa E. Fernández-Pardo
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain;
- Physiotherapy Department, Ramón y Cajal University Hospital, 28034 Madrid, Spain
| | - Ángela Aguilera-Rubio
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain
- Motion Analysis, Ergonomics, Biomechanics and Motor Control Laboratory (LAMBECOM), Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain
| | - Francisco Molina-Rueda
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain
- Motion Analysis, Ergonomics, Biomechanics and Motor Control Laboratory (LAMBECOM), Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain
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Pereira S, Silva A, Santos R, Costa Silva C. Assessing Postural Control From Birth to Adulthood Among Individuals Born Preterm: A Systematic Review. Motor Control 2024; 28:276-304. [PMID: 38580301 DOI: 10.1123/mc.2023-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/02/2024] [Accepted: 01/30/2024] [Indexed: 04/07/2024]
Abstract
Premature life exposure, meaning an immature central nervous system, presents a significant challenge for the development of postural control and, in turn, overall motor development. Preventing motor delay thus requires identifying, characterizing, and quantifying deficit in postural control as early as possible. In our study, we reviewed the procedures used in past studies to assess postural control among individuals born preterm, specifically the characterization of participants, the instruments and motor tasks involved, the types of data collected and analyzed, and the outcomes. To that end, we performed a literature search on PubMed, Wiley Online Library, Web of Science, and Scopus using Boolean logic and assessed the quality of the studies with a standardized assessment based on the Strengthening the Reporting of Observational Studies in Epidemiology guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. Of 35 potential studies, 24 were included; all evaluated infants born preterm, but six did not include a control group of full-term infants. Although the heterogeneity of measurements, variability of instruments, and divergence in motor tasks examined limit definitive conclusions based on quantitative synthesis and the generalization of the results, most studies revealed dysfunctional postural control among individuals born preterm.
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13
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Parikh V, Medley A, Goh HT. Effects of rTMS to primary motor cortex and cerebellum on balance control in healthy adults. Eur J Neurosci 2024; 60:3984-3994. [PMID: 38721642 DOI: 10.1111/ejn.16386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 04/13/2024] [Accepted: 04/22/2024] [Indexed: 07/21/2024]
Abstract
Both the primary motor cortex (M1) and the cerebellum are crucial for postural stability and deemed as potential targets for non-invasive brain stimulation (NIBS) to enhance balance performance. However, the optimal target remains unknown. The purpose of this study was to compare the role of M1 and the cerebellum in modulating balance performance in young healthy adults using facilitatory 5 Hz repetitive transcranial magnetic stimulation (rTMS). Twenty-one healthy young adults (mean age = 27.95 ± 1.15 years) received a single session of 5 Hz rTMS on M1 and the cerebellum in a cross-over order with a 7-day washout period between the two sessions. Three balance assessments were performed on the Biodex Balance system SD: Limits of Stability (LOS), modified Clinical Test of Sensory Interaction on Balance (mCTSIB), and Balance Error Scoring System (BESS). No significant effect of rTMS was found on the LOS. The effect of rTMS on the mCTSIB was mediated by stimulation target, proprioception, and vision (p = .003, ηp 2 = 0.37). Cerebellar rTMS improved the mCTSIB sway index under eyes closed-foam surface condition (p = .02), whereas M1 rTMS did not result in improvement on the mCTSIB. The effect of rTMS on the BESS was mediated by stimulation target, posture, and proprioception (p = .049, ηp 2 = 0.14). Cerebellar rTMS enhanced reactive balance performance during most sensory deprived conditions.
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Affiliation(s)
- Vyoma Parikh
- School of Physical Therapy, Texas Woman's University, United States
- School of Medicine, Emory University, United States
| | - Ann Medley
- School of Physical Therapy, Texas Woman's University, United States
| | - Hui-Ting Goh
- School of Physical Therapy, Texas Woman's University, United States
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14
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Wodarski P, Jurkojć J, Chmura M, Warmerdam E, Romijnders R, Hobert MA, Maetzler W, Cygoń K, Hansen C. Trend change analysis of postural balance in Parkinson's disease discriminates between medication state. J Neuroeng Rehabil 2024; 21:112. [PMID: 38943208 PMCID: PMC11212256 DOI: 10.1186/s12984-024-01411-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 06/20/2024] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND Maintaining static balance is relevant and common in everyday life and it depends on a correct intersegmental coordination. A change or reduction in postural capacity has been linked to increased risk of falls. People with Parkinson's disease (pwPD) experience motor symptoms affecting the maintenance of a stable posture. The aim of the study is to understand the intersegmental changes in postural sway and to apply a trend change analysis to uncover different movement strategies between pwPD and healthy adults. METHODS In total, 61 healthy participants, 40 young (YO), 21 old participants (OP), and 29 pwPD (13 during medication off, PDoff; 23 during medication on, PDon) were included. Participants stood quietly for 10 s as part of the Short Physical Performance Battery. Inertial measurement units (IMU) at the head, sternum, and lumbar region were used to extract postural parameters and a trend change analysis (TCA) was performed to compare between groups. OBJECTIVE This study aims to explore the potential application of TCA for the assessment of postural stability using IMUs, and secondly, to employ this analysis within the context of neurological diseases, specifically Parkinson's disease. RESULTS Comparison of sensors locations revealed significant differences between head, sternum and pelvis for almost all parameters and cohorts. When comparing PDon and PDoff, the TCA revealed differences that were not seen by any other parameter. CONCLUSIONS While all parameters could differentiate between sensor locations, no group differences could be uncovered except for the TCA that allowed to distinguish between the PD on/off. The potential of the TCA to assess disease progression, response to treatment or even the prodromal PD phase should be explored in future studies. TRIAL REGISTRATION The research procedure was approved by the ethical committee of the Medical Faculty of Kiel University (D438/18). The study is registered in the German Clinical Trials Register (DRKS00022998).
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Affiliation(s)
- Piotr Wodarski
- Faculty of Biomedical Engineering, Department of Biomechatronics, Silesian University of Technology, Gliwice, Poland
| | - Jacek Jurkojć
- Faculty of Biomedical Engineering, Department of Biomechatronics, Silesian University of Technology, Gliwice, Poland
| | - Marta Chmura
- Faculty of Biomedical Engineering, Department of Biomechatronics, Silesian University of Technology, Gliwice, Poland
| | - Elke Warmerdam
- Division of Surgery, Saarland University, 66421, Homburg, Germany
| | | | - Markus A Hobert
- Department of Neurology, Kiel University, 24105, Kiel, Germany
| | - Walter Maetzler
- Department of Neurology, Kiel University, 24105, Kiel, Germany
| | | | - Clint Hansen
- Department of Neurology, Kiel University, 24105, Kiel, Germany.
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15
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Hung YT, Wu RM, Huang CY. Differentiation in theta and gamma activation in weight-shifting learning between people with parkinson's disease of different anxiety severities. GeroScience 2024:10.1007/s11357-024-01236-7. [PMID: 38890205 DOI: 10.1007/s11357-024-01236-7] [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: 10/25/2023] [Accepted: 05/31/2024] [Indexed: 06/20/2024] Open
Abstract
Anxiety and postural control deficits may be related in people with Parkinson's disease (PwPD). However, the association between anxiety levels and weight-shifting control remains ambiguous. This study investigated whether 1) weight-shifting control differed between PwPD with and without anxiety, and 2) the learning effect of weight-shifting differed between the two populations. Additionally, we evaluated cortical activities to investigate neural mechanisms underlying weight-shifting control. Twenty-eight PwPD (14 anxiety, 14 nonanxiety) participated in a 5-day weight-shifting study by coupling the bearing weight of their more-affected leg to a sinusoidal target at 0.25 Hz. We tested the weight-shifting control on day 1 (pretest), day 3 (posttest), and day 5 (retention test) with a learning session on day 3. The error and jerk of weight-shifting trajectory and the theta and gamma powers of electroencephalography in prefrontal, frontal, sensorimotor and parietal-occipital areas were measured. At the pretest, the anxiety group showed larger error and smaller jerk of weight-shifting with greater prefrontal theta, frontal gamma, and sensorimotor gamma powers than the nonanxiety group. Anxiety intensity was correlated positively with weight-shifting error and theta power but negatively with weight-shifting jerk. Reduced weight-shifting error with increased theta power after weight-shifting learning was observed in the nonanxiety group. However, the anxiety group showed decreased gamma power after weight-shifting learning without behavior change. Our findings suggest differential weight-shifting control and associated cortical activation between PwPD with and without anxiety. In addition, anxiety would deteriorate weight-shifting control and hinder weight-shifting learning benefits in PwPD, leading to less weight-shifting accuracy and correction.
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Affiliation(s)
- Yu-Ting Hung
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ruey-Meei Wu
- Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Cheng-Ya Huang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
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16
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Chang JJ, Chen YC, Yeh SL, Tang PF, Tu CK. Impacts of audiovisual simultaneity perception on single-task and dual-task gaits in middle-aged and older adults. Gait Posture 2024; 113:99-105. [PMID: 38850854 DOI: 10.1016/j.gaitpost.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 05/18/2024] [Accepted: 06/04/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND While dual-task walking requires the ability to integrate sensory information from multiple ongoing sources, it remains unknown whether dual-task walking is more affected than single-task walking by the multisensory integration ability. RESEARCH QUESTION How does the audiovisual temporal integration ability affect single-task and dual-task gaits in the aging population? METHODS One hundred and thirty healthy middle-aged and older adults (age = 64.7 ± 6.4 years) completed an audiovisual simultaneity judgment (AVSJ) task and underwent single-task, motor dual-task, and cognitive dual-task gait assessments. In the AVSJ task, participants judged whether a flash and an auditory stimulus presented at different stimulus onset asynchronies were simultaneous. The accuracy and precision of the AVSJ performance were assessed using the point of subjective simultaneity (PSS) and the temporal binding window (δ), respectively. A lower absolute PSS and δ indicated better performance. Participants held a cup of water and performed serial-7 subtraction for motor and cognitive dual-task gait assessments, respectively. The spatiotemporal gait parameters and their variability were calculated. The influences of PSS and δ on the gait parameters of the three gaits were examined with multiple hierarchical regressions. RESULTS Only the cognitive dual-task gait was significantly affected by PSS and δ. Greater PSS predicted a longer single support time (β = 0.195, p = 0.024) and its variability (β = 0.224, p = 0.011). Greater δ predicted greater step time variability (β = 0.198, p = 0.022). SIGNIFICANCE Declined perception of audiovisual simultaneity particularly degrades temporal control of cognitive dual-task walking, highlighting the importance of assessing and training this ability after midlife.
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Affiliation(s)
- Jer-Jen Chang
- Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Chuan Chen
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Su-Ling Yeh
- Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Psychology, College of Science, National Taiwan University, Taipei, Taiwan; Neurobiology and Cognitive Science Center, National Taiwan University, Taipei, Taiwan; Center for Artificial Intelligence and Robotics, National Taiwan University, Taipei, Taiwan
| | - Pei-Fang Tang
- Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan; Neurobiology and Cognitive Science Center, National Taiwan University, Taipei, Taiwan; Center for Artificial Intelligence and Robotics, National Taiwan University, Taipei, Taiwan; School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.
| | - Chien-Kuang Tu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Rehabilitation Department, Sin-Wu Branch, Tao-Yuan General Hospital, Ministry of Health and Welfare, Taiwan
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Hou W, Wu F, Wang Y, Li W, Cheng Y, Zhu Z, Liang S, Liu P, Yu Y, Wu J. Predicting slight freezing of gait in Parkinson's disease with anticipatory postural adjustments and limits of stability. Parkinsonism Relat Disord 2024; 123:106949. [PMID: 38564831 DOI: 10.1016/j.parkreldis.2024.106949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/20/2024] [Accepted: 03/23/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Gait initiation (GI) includes automatic and voluntary movements. However, research on their impact on the first step in patients with Parkinson's disease (PD) and their relationship to freezing of gait (FOG) is lacking. We examined the effects of automatic movements (anticipatory postural adjustments [APAs]) and voluntary movements (limits of stability [LOS]) on the first step (first-step duration and first-step range of motion), along with their early recognition and prediction of slight FOG. METHODS Twenty-three patients with PD and slight freezing (PD + FOG) and 25 non-freezing patients with PD (PD-FOG) were tested while off medications and compared with 24 healthy controls (HC). All participants completed a 7-m Stand and Walk Test (7 m SAW) and wore inertial sensors to quantify the APAs and first step. LOS was quantified by dynamic posturography in different directions using a pressure platform. We compared differences among all three groups, analysed correlations, and evaluated their predictive value for slight FOG. RESULTS In PD + FOG, APAs and LOS were worse than those in the PD-FOG and HC groups (p < 0.001), and the first step was worse than that in HC (p < 0.001). APAs were correlated mainly with the first-step duration. APAs and LOS were correlated with the first-step range of motion. APAs have been recognized as independent predictors of FOG, and their combination with LOS enhances predictive sensitivity. CONCLUSION APAs and LOS in patients with PD directly affect the first step during GI. In addition, the combination of APAs and LOS helped predict slight FOG.
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Affiliation(s)
- Weijia Hou
- Department of Rehabilitation, Tianjin Huanhu Hospital, Tianjin, 300350, China
| | - Fan Wu
- Department of Rehabilitation, Tianjin Huanhu Hospital, Tianjin, 300350, China
| | - Yue Wang
- Department of Rehabilitation, Tianjin Huanhu Hospital, Tianjin, 300350, China
| | - Weihua Li
- Department of Rehabilitation, Tianjin Huanhu Hospital, Tianjin, 300350, China
| | - Yuanyuan Cheng
- Department of Rehabilitation, Tianjin Huanhu Hospital, Tianjin, 300350, China
| | - Zhizhong Zhu
- Department of Rehabilitation, Tianjin Huanhu Hospital, Tianjin, 300350, China
| | - Siquan Liang
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, 300350, China
| | - Peipei Liu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin, 300350, China
| | - Yang Yu
- Department of Rehabilitation, Tianjin Huanhu Hospital, Tianjin, 300350, China.
| | - Jialing Wu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin, 300350, China.
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18
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Kim E, Yun SJ, Oh BM, Seo HG. Changes of neural coupling between cognitive and motor networks associated with dual-task performance in Parkinson's disease. Neurol Sci 2024; 45:2651-2659. [PMID: 38153677 DOI: 10.1007/s10072-023-07255-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/02/2023] [Indexed: 12/29/2023]
Abstract
BACKGOUND Although cognitive control is essential for efficient gait, the associations between cognitive and motor networks regarding gait in individuals with Parkinson's disease (PD) remain to be determined. Herein, we enrolled 28 PD and 28 controls to compare internetwork coupling among cognitive and motor networks and examine its relationship with single- and dual-task gait performance in PD. METHODS The dorsal attention network (DAN), left and right frontoparietal control networks (FPNs), sensorimotor network, and lateral motor network were identified using resting-state functional magnetic resonance imaging data. The time taken to complete a 10-m walk test during cognitive or physical dual-tasks in PD was calculated representing gait performance. RESULTS We observed that the internetwork couplings between the DAN and motor networks and between the motor networks decreased whereas those between the left FPN and DAN and motor networks increased in PD compared to controls using a permutation test. There was no significant correlation between the internetwork couplings and single- and dual-task gait performance in PD. Nevertheless, improved cognitive dual-task performance showed a positive correlation with the DAN and left FPN coupling and a negative correlation with the DAN and lateral motor network coupling in a good performance group. The opposite relationship was observed in the poor cognitive dual-task performance group. CONCLUSION Our findings suggest a neural mechanism of cognitive control on gait to compensate for reduced goal-directed attention in PD who maintain cognitive dual-task performance.
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Affiliation(s)
- Eunkyung Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
- Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Seo Jung Yun
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
- Institute On Aging, Seoul National University, 1, Gwanak-Ro, Gwanak-Gu, Seoul, 08826, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
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19
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Hellmann D, Fadillioglu C, Kanus L, Möhler F, Schindler HJ, Schmitter M, Stein T, Ringhof S. Influence of oral motor tasks on postural muscle activity during dynamic reactive balance. J Oral Rehabil 2024; 51:1041-1049. [PMID: 38491728 DOI: 10.1111/joor.13659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/06/2024] [Accepted: 02/05/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Jaw clenching improves dynamic reactive balance on an oscillating platform during forward acceleration and is associated with decreased mean sway speed of different body regions. OBJECTIVE It is suggested that jaw clenching as a concurrent muscle activity facilitates human motor excitability, increasing the neural drive to distal muscles. The underlying mechanism behind this phenomenon was studied based on leg and trunk muscle activity (iEMG) and co-contraction ratio (CCR). METHODS Forty-eight physically active and healthy adults were assigned to three groups, performing three oral motor tasks (jaw clenching, tongue pressing against the palate or habitual lower jaw position) during a dynamic one-legged stance reactive balance task on an oscillating platform. The iEMG and CCR of posture-relevant muscles and muscle pairs were analysed during platform forward acceleration. RESULTS Tongue pressing caused an adjustment of co-contraction patterns of distal muscle groups based on changes in biomechanical coupling between the head and trunk during static balancing at the beginning of the experiment. Neither iEMG nor CCR measurement helped detect a general neuromuscular effect of jaw clenching on the dynamic reactive balance. CONCLUSION The findings might indicate the existence of robust fixed patterns of rapid postural responses during the important initial phases of balance recovery.
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Affiliation(s)
- Daniel Hellmann
- Department of Prosthodontics, University of Würzburg, Würzburg, Germany
- Dental Academy for Continuing Professional Development, Karlsruhe, Germany
| | - Cagla Fadillioglu
- BioMotion Center, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Lisa Kanus
- Department of Prosthodontics, University of Würzburg, Würzburg, Germany
| | - Felix Möhler
- BioMotion Center, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Hans J Schindler
- Dental Academy for Continuing Professional Development, Karlsruhe, Germany
| | - Marc Schmitter
- Department of Prosthodontics, University of Würzburg, Würzburg, Germany
| | - Thorsten Stein
- BioMotion Center, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Steffen Ringhof
- Department of Sport and Sport Science, University of Freiburg, Freiburg, Germany
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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20
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Kim HY, An YS, Oh SH, Lee HC. Clinical Feasibility of a Markerless Gait Analysis System. Clin Orthop Surg 2024; 16:506-516. [PMID: 38827756 PMCID: PMC11130620 DOI: 10.4055/cios23065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 01/11/2024] [Accepted: 01/11/2024] [Indexed: 06/04/2024] Open
Abstract
Background The gait analysis method that has been used in clinical practice to date is an optical tracking system (OTS) using a marker, but a markerless gait analysis (MGA) system is being developed because of the expensive cost and complicated examination of the OTS. To apply this MGA clinically, a comparative study of the MGA and OTS methods is necessary. The purpose of this study was to evaluate the compatibility between the OTS and the MGA methods and to evaluate the usefulness of the MGA system in actual clinical settings. Methods From March 2021 to August 2021, 14 patients underwent gait analysis using the OTS and MGA system, and the spatiotemporal parameters and kinematic results obtained by the 2 methods were compared. To evaluate the practicality of the MGA system in an actual clinical setting, MGA was performed on 14 symptomatic children with idiopathic toe walking, who had been treated with a corrective cast, and the pre-cast and post-cast results were compared. For the OTS, the Motion Analysis Eagle system was used, and for MGA, DH Walk was used. Results The spatiotemporal parameters showed no significant difference between the OTS and MGA system. The joint angle graphs of the kinematics along the sagittal plane showed similar shapes as a whole, with particularly high correlations in the hip and knee (pelvis: 29.4%, hip joint: 96.7%, knee joint: 94.9%, and ankle joint: 68.5%). A quantified comparison using the CORrelation and Analysis (CORA) score also showed high similarity between the 2 methods. The MGA results of pre-cast application and post-cast removal for children with idiopathic toe walking showed a statistically significant improvement in ankle dorsiflexion after treatment (p < 0.001). Conclusions MGA showed a good correlation with the conventional OTS in terms of spatiotemporal parameters and kinematics. We demonstrated that ankle sagittal kinematics improved after treatment by corrective cast in children with idiopathic toe walking using the MGA method. Thus, after the improvement of a few limitations, the MGA system may soon be able to be clinically applied.
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Affiliation(s)
- Ha Yong Kim
- Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea
| | - Young Sun An
- Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea
| | - Seung Hak Oh
- Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea
| | - Han Cheol Lee
- Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea
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21
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Miller LR, Bickel MA, Vance ML, Vaden H, Nagykaldi D, Nyul-Toth A, Bullen EC, Gautam T, Tarantini S, Yabluchanskiy A, Kiss T, Ungvari Z, Conley SM. Vascular smooth muscle cell-specific Igf1r deficiency exacerbates the development of hypertension-induced cerebral microhemorrhages and gait defects. GeroScience 2024; 46:3481-3501. [PMID: 38388918 PMCID: PMC11009188 DOI: 10.1007/s11357-024-01090-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/03/2024] [Indexed: 02/24/2024] Open
Abstract
Cerebrovascular fragility and cerebral microhemorrhages (CMH) contribute to age-related cognitive impairment, mobility defects, and vascular cognitive impairment and dementia, impairing healthspan and reducing quality of life in the elderly. Insulin-like growth factor 1 (IGF-1) is a key vasoprotective growth factor that is reduced during aging. Circulating IGF-1 deficiency leads to the development of CMH and other signs of cerebrovascular dysfunction. Here our goal was to understand the contribution of IGF-1 signaling on vascular smooth muscle cells (VSMCs) to the development of CMH and associated gait defects. We used an inducible VSMC-specific promoter and an IGF-1 receptor (Igf1r) floxed mouse line (Myh11-CreERT2 Igf1rf/f) to knockdown Igf1r. Angiotensin II in combination with L-NAME-induced hypertension was used to elicit CMH. We observed that VSMC-specific Igf1r knockdown mice had accelerated development of CMH, and subsequent associated gait irregularities. These phenotypes were accompanied by upregulation of a cluster of pro-inflammatory genes associated with VSMC maladaptation. Collectively our findings support an essential role for VSMCs as a target for the vasoprotective effects of IGF-1, and suggest that VSMC dysfunction in aging may contribute to the development of CMH.
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Affiliation(s)
- Lauren R Miller
- Department of Cell Biology, University of Oklahoma Health Sciences Center, 940 Stanton L. Young Blvd, BMSB 553, Oklahoma City, OK, 73104, USA
- Currently at: Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA
| | - Marisa A Bickel
- Department of Cell Biology, University of Oklahoma Health Sciences Center, 940 Stanton L. Young Blvd, BMSB 553, Oklahoma City, OK, 73104, USA
| | - Michaela L Vance
- Department of Cell Biology, University of Oklahoma Health Sciences Center, 940 Stanton L. Young Blvd, BMSB 553, Oklahoma City, OK, 73104, USA
| | - Hannah Vaden
- Department of Cell Biology, University of Oklahoma Health Sciences Center, 940 Stanton L. Young Blvd, BMSB 553, Oklahoma City, OK, 73104, USA
| | - Domonkos Nagykaldi
- Department of Cell Biology, University of Oklahoma Health Sciences Center, 940 Stanton L. Young Blvd, BMSB 553, Oklahoma City, OK, 73104, USA
| | - Adam Nyul-Toth
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Elizabeth C Bullen
- Department of Cell Biology, University of Oklahoma Health Sciences Center, 940 Stanton L. Young Blvd, BMSB 553, Oklahoma City, OK, 73104, USA
| | - Tripti Gautam
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Stefano Tarantini
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
- The Peggy and Charles Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Andriy Yabluchanskiy
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Tamas Kiss
- Pediatric Center, Semmelweis University, Budapest, Hungary
- Eötvös Loránd Research Network and Semmelweis University Cerebrovascular and Neurocognitive Disorders Research Group, Budapest, Hungary
| | - Zoltan Ungvari
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- The Peggy and Charles Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Shannon M Conley
- Department of Cell Biology, University of Oklahoma Health Sciences Center, 940 Stanton L. Young Blvd, BMSB 553, Oklahoma City, OK, 73104, USA.
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA.
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22
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Brito R, Fabrício JV, Araujo A, Barreto G, Baltar A, Monte-Silva K. Single-Session Cerebellar Transcranial Direct Current Stimulation Improves Postural Stability and Reduces Ataxia Symptoms in Spinocerebellar Ataxia. CEREBELLUM (LONDON, ENGLAND) 2024:10.1007/s12311-024-01696-9. [PMID: 38693314 DOI: 10.1007/s12311-024-01696-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/20/2024] [Indexed: 05/03/2024]
Abstract
Spinocerebellar ataxia (SCA) results in balance and coordination impairment, and current treatments have limited efficacy. Recent evidence suggests that combining postural training with cerebellar transcranial direct current stimulation (ctDCS) can improve these symptoms. However, the combined effects of ctDCS and postural training on individuals with spinocerebellar ataxia remain underexplored. Ten volunteers with (SCA type 3) participated in a triple-blind, randomized, crossover study to receive a single session of ctDCS (2 mA for 20 min) and a sham ctDCS session separated by at least one week. The Biodex Balance System was used to assess balance at each session, measuring overall stability index, anteroposterior stability index, and medial-lateral stability index. As secondary outcomes, cerebellar ataxia symptoms were evaluated using the 8-item Scale for Assessment and Rating of Ataxia. The assessments were conducted before and after each session. The results indicated that ctDCS enhanced the overall stability index when compared to sham ctDCS (Z = -2.10, p = 0.03), although it did not significantly affect the anteroposterior or medial-lateral stability indices. Compared to the baseline, a single session of ctDCS reduced appendicular symptoms related to cerebellar ataxia, as evidenced by improvements in the nose-finger test (Z = -2.07, p = 0.04), fast alternating hand movements (Z = -2.15, p = 0.03), and heel-to-shin slide (Z = -1.91, p = 0.05). In conclusion, our study suggests that a single session of ctDCS, in combination with postural training, can enhance balance and alleviate ataxia symptoms in individuals with cerebellar ataxia. This study was approved by the local research ethics committee (No. 2.877.813) and registered on clinicaltrials.org (NCT04039048 - https://www.clinicaltrials.gov/study/NCT04039048 ) on 2019-07-28.
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Affiliation(s)
- Rodrigo Brito
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Jornalista Aníbal Fernandes Avenue, Recife, 50740-560, PE, Brasil
- NAPeN Network (Núcleo de Assistência e Pesquisa em Neuromodulação), Palmares, Pernambuco, Brazil
| | - João Victor Fabrício
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Jornalista Aníbal Fernandes Avenue, Recife, 50740-560, PE, Brasil
| | - Aurine Araujo
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Jornalista Aníbal Fernandes Avenue, Recife, 50740-560, PE, Brasil
| | - Gabriel Barreto
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Jornalista Aníbal Fernandes Avenue, Recife, 50740-560, PE, Brasil
- NAPeN Network (Núcleo de Assistência e Pesquisa em Neuromodulação), Palmares, Pernambuco, Brazil
| | - Adriana Baltar
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Jornalista Aníbal Fernandes Avenue, Recife, 50740-560, PE, Brasil
- NAPeN Network (Núcleo de Assistência e Pesquisa em Neuromodulação), Palmares, Pernambuco, Brazil
| | - Kátia Monte-Silva
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Jornalista Aníbal Fernandes Avenue, Recife, 50740-560, PE, Brasil.
- NAPeN Network (Núcleo de Assistência e Pesquisa em Neuromodulação), Palmares, Pernambuco, Brazil.
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23
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Minami K, Yamanaka E, Okuyama K, Kawakami M, Kondo K, Ishizaka R, Takahashi A, Watanabe T. Working memory load modulates anticipatory postural adjustments during step initiation. Exp Brain Res 2024; 242:1215-1223. [PMID: 38526741 DOI: 10.1007/s00221-024-06820-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/12/2024] [Indexed: 03/27/2024]
Abstract
Working memory (WM) can influence selective attention. However, the effect of WM load on postural standing tasks has been poorly understood, even though these tasks require attentional resources. The purpose of this study was to examine whether WM load would impact anticipatory postural adjustments (APAs) during step initiation. Sixteen healthy young adults performed stepping tasks alone or concurrently with a WM task in a dual-task design. The stepping tasks involved volitional stepping movements in response to visual stimuli and comprised of simple and choice reaction time tasks and the Flanker task which consisted of congruent and incongruent (INC) conditions. In the dual-task condition, subjects were required to memorize either one or six digits before each stepping trial. Incorrect weight transfer prior to foot-lift, termed APA errors, reaction time (RT), and foot-lift time were measured from the vertical force data. The results showed that APA error rate was significantly higher when memorizing six-digit than one-digit numerals in the INC condition. In addition, RT and foot-lift time were significantly longer in the INC condition compared to the other stepping conditions, while there was no significant effect of WM load on RT or foot-lift time. These findings suggest that high WM load reduces the cognitive resources needed for selective attention and decision making during step initiation.
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Affiliation(s)
- Kodai Minami
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
- Graduate School of Health Sciences, Aomori University of Health and Welfare, 58-1 Mase, Hamadate, Aomori, 030-8505, Japan
| | - Eiji Yamanaka
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
- Department of Health Sciences, Graduate School of Medicine, Shinshu University, Nagano, Japan
| | - Kohei Okuyama
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kunitsugu Kondo
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Riku Ishizaka
- Graduate School of Health Sciences, Aomori University of Health and Welfare, 58-1 Mase, Hamadate, Aomori, 030-8505, Japan
| | - Aoki Takahashi
- Graduate School of Health Sciences, Aomori University of Health and Welfare, 58-1 Mase, Hamadate, Aomori, 030-8505, Japan
| | - Tatsunori Watanabe
- Graduate School of Health Sciences, Aomori University of Health and Welfare, 58-1 Mase, Hamadate, Aomori, 030-8505, Japan.
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24
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Park E, Lee S, Jung TD, Park KS, Lee JT, Kang K. Changes in postural stability after cerebrospinal fluid tap test in patients with idiopathic normal pressure hydrocephalus. Front Neurol 2024; 15:1361538. [PMID: 38751889 PMCID: PMC11094259 DOI: 10.3389/fneur.2024.1361538] [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: 12/26/2023] [Accepted: 02/12/2024] [Indexed: 05/18/2024] Open
Abstract
Introduction In patients with idiopathic normal pressure hydrocephalus (iNPH), the characteristics of balance disturbance are not as well understood as those related to gait. This study examined changes in postural stability in quiet standing after the cerebrospinal fluid tap test (CSFTT) in these patients. Furthermore, the study explored the relationship between the amount of spontaneous body sway and both gait and executive function. Materials and methods All patients diagnosed with iNPH underwent CSFTT. We evaluated their center of pressure (COP) measurements on a force plate during quiet standing, both pre- and post-CSFTT. Following the COP measurements, we calculated COP parameters using time and frequency domain analysis and assessed changes in these parameters after CSFTT. At pre-CSFTT, we assessed the Timed Up and Go (TUG) and the Frontal Assessment Battery (FAB). We investigated the relationship between COP parameters and the TUG and FAB scores at pre-CSFTT. Results A total of 72 patients with iNPH were initially enrolled, and 56 patients who responded positively to CSFTT were finally included. Post-CSFTT, significant improvements were observed in COP parameters through time domain analysis. These included the velocity of COP (vCOP), root-mean-square of COP (rmsCOP), turn index, torque, and base of support (BOS), compared to the pre-CSFTT values (p < 0.05). In the frequency domain analysis of COP parameters post-CSFTT, there was a decrease in both the peak and average of power spectral density (PSD) values in both the anteroposterior (AP) and mediolateral (ML) directions below 0.5 Hz (p < 0.05). In addition, the TUG scores showed a positive correlation with vCOP, rmsCOP, turn index, torque, BOS, and both the peak and average PSD values in the AP and ML directions below 0.5 Hz (p < 0.05). The FAB scores demonstrated a negative correlation with vCOP, rmsCOP, turns index, BOS, and both peak and average PSD values in the AP direction below 0.5 Hz (p < 0.05). Conclusion In patients with iNPH who responded to CSFTT, there was an improvement in spontaneous body sway during quiet standing after CSFTT. Increased spontaneous sway is associated with impaired gait and frontal lobe function. This may be linked to impaired cortico-cortical and cortico-subcortical circuits in patients with iNPH.
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Affiliation(s)
- Eunhee Park
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Sanghyeon Lee
- School of Computer Science and Engineering, Kyungpook National University, Daegu, Republic of Korea
| | - Tae-Du Jung
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Ki-Su Park
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jong Taek Lee
- School of Computer Science and Engineering, Kyungpook National University, Daegu, Republic of Korea
| | - Kyunghun Kang
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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25
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Wang R, Jin Z, Zhen Q, Qi L, Liu C, Wang P, Liu Y, Fang J, Liu Y, Su Y, Wang Y, Meng D, Yan H, Zhen Y, Li Z, Fang B. Hyperglycemia affects axial signs in patients with Parkinson's disease through mechanisms of insulin resistance or non-insulin resistance. Neurol Sci 2024; 45:2011-2019. [PMID: 38146011 DOI: 10.1007/s10072-023-07273-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/14/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE To investigate the influence of hyperglycemia on motor symptoms, especially axial signs, and potential mechanisms related to insulin resistance (IR) in patients with Parkinson's disease (PWP). METHODS According to glycated hemoglobin (HbA1c) level, PWP were divided into the low-HbA1c and the high-HbA1c groups. Demographic information, glucose metabolism-related variables, Hoehn-Yahr stage, and motor function were compared between the two groups. Correlations between levels of HbA1c and the homeostatic model assessment (HOMA)-IR and motor function in PWP were further analyzed. RESULTS HbA1c level was significantly and positively correlated with the Movement Disorder Society Unified Parkinson's Disease Rating Scale Part III score, axial signs subscore, the Timed Get Up and Go test time, the center of pressure displacement of standing with eyes open and closed, and significantly and negatively correlated with the 10-m walk test comfortable gait speed. HOMA-IR level was significantly and negatively correlated with 10-m walk test comfortable gait speed, but not with others. CONCLUSIONS PWP with high HbA1c showed worse axial symptoms, including dysfunction of automatic walking, dynamic balance, and postural control than those with low HbA1c. In PWP, the effects of hyperglycemia on automatic walking speed may be associated with the IR-related mechanisms, and the effects on dynamic balance and postural control may be related to mechanisms other than IR.
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Affiliation(s)
- Ruidan Wang
- Neurological Rehabilitation Center, Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, 100144, China
| | - Zhaohui Jin
- Neurological Rehabilitation Center, Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, 100144, China
| | - Qiaoxia Zhen
- Neurological Rehabilitation Center, Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, 100144, China
| | - Lin Qi
- Neurological Rehabilitation Center, Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, 100144, China
| | - Cui Liu
- Neurological Rehabilitation Center, Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, 100144, China
| | - Ping Wang
- Neurological Rehabilitation Center, Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, 100144, China
| | - Yonghong Liu
- Neurological Rehabilitation Center, Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, 100144, China
| | - Jinping Fang
- Neurological Rehabilitation Center, Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, 100144, China
| | - Yanjun Liu
- Neurological Rehabilitation Center, Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, 100144, China
| | - Yuan Su
- Neurological Rehabilitation Center, Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, 100144, China
| | - Yixuan Wang
- Neurological Rehabilitation Center, Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, 100144, China
| | - Detao Meng
- Neurological Rehabilitation Center, Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, 100144, China
| | - Hongjiao Yan
- Neurological Rehabilitation Center, Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, 100144, China
| | - Yi Zhen
- Neurological Rehabilitation Center, Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, 100144, China
| | - Zhenzhen Li
- Neurological Rehabilitation Center, Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, 100144, China
| | - Boyan Fang
- Neurological Rehabilitation Center, Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, 100144, China.
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26
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Bonassi G, Zhao M, Samogin J, Mantini D, Marchese R, Contrino L, Tognetti P, Putzolu M, Botta A, Pelosin E, Avanzino L. Brain Networks Modulation during Simple and Complex Gait: A "Mobile Brain/Body Imaging" Study. SENSORS (BASEL, SWITZERLAND) 2024; 24:2875. [PMID: 38732980 PMCID: PMC11086305 DOI: 10.3390/s24092875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/24/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024]
Abstract
Walking encompasses a complex interplay of neuromuscular coordination and cognitive processes. Disruptions in gait can impact personal independence and quality of life, especially among the elderly and neurodegenerative patients. While traditional biomechanical analyses and neuroimaging techniques have contributed to understanding gait control, they often lack the temporal resolution needed for rapid neural dynamics. This study employs a mobile brain/body imaging (MoBI) platform with high-density electroencephalography (hd-EEG) to explore event-related desynchronization and synchronization (ERD/ERS) during overground walking. Simultaneous to hdEEG, we recorded gait spatiotemporal parameters. Participants were asked to walk under usual walking and dual-task walking conditions. For data analysis, we extracted ERD/ERS in α, β, and γ bands from 17 selected regions of interest encompassing not only the sensorimotor cerebral network but also the cognitive and affective networks. A correlation analysis was performed between gait parameters and ERD/ERS intensities in different networks in the different phases of gait. Results showed that ERD/ERS modulations across gait phases in the α and β bands extended beyond the sensorimotor network, over the cognitive and limbic networks, and were more prominent in all networks during dual tasks with respect to usual walking. Correlation analyses showed that a stronger α ERS in the initial double-support phases correlates with shorter step length, emphasizing the role of attention in motor control. Additionally, β ERD/ERS in affective and cognitive networks during dual-task walking correlated with dual-task gait performance, suggesting compensatory mechanisms in complex tasks. This study advances our understanding of neural dynamics during overground walking, emphasizing the multidimensional nature of gait control involving cognitive and affective networks.
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Affiliation(s)
- Gaia Bonassi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy;
| | - Mingqi Zhao
- Research Center for Motor Control and Neuroplasticity, KU Leuven, 3001 Leuven, Belgium; (M.Z.); (J.S.); (D.M.)
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou 730000, China
| | - Jessica Samogin
- Research Center for Motor Control and Neuroplasticity, KU Leuven, 3001 Leuven, Belgium; (M.Z.); (J.S.); (D.M.)
| | - Dante Mantini
- Research Center for Motor Control and Neuroplasticity, KU Leuven, 3001 Leuven, Belgium; (M.Z.); (J.S.); (D.M.)
| | - Roberta Marchese
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (R.M.); (A.B.); (L.A.)
| | - Luciano Contrino
- S.C. Medicina Fisica e Riabilitazione Ospedaliera, Azienda Sanitaria Locale Chiavarese, 16043 Chiavari, Italy; (L.C.); (P.T.)
| | - Paola Tognetti
- S.C. Medicina Fisica e Riabilitazione Ospedaliera, Azienda Sanitaria Locale Chiavarese, 16043 Chiavari, Italy; (L.C.); (P.T.)
| | - Martina Putzolu
- Department of Experimental Medicine, Section of Human Physiology, University of Genoa, Viale Benedetto XV 3, 16132 Genoa, Italy;
| | - Alessandro Botta
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (R.M.); (A.B.); (L.A.)
| | - Elisa Pelosin
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy;
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (R.M.); (A.B.); (L.A.)
| | - Laura Avanzino
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (R.M.); (A.B.); (L.A.)
- Department of Experimental Medicine, Section of Human Physiology, University of Genoa, Viale Benedetto XV 3, 16132 Genoa, Italy;
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Wodarski P, Chmura M, Szlęzak M, Bajor G, Gzik M, Jurkojć J. Trend change analysis in the assessment of body balance during posture adjustment in reaction to anterior-posterior ground perturbation. PLoS One 2024; 19:e0301227. [PMID: 38687726 PMCID: PMC11060584 DOI: 10.1371/journal.pone.0301227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/12/2024] [Indexed: 05/02/2024] Open
Abstract
Postural adjustments (PA) occur to counteract predictable perturbations and can be impaired as a result of musculoskeletal and neurological dysfunctions. The most common way to detect PA is through electromyography measurements or center of pressure (COP) position measurements, where analysis in time domain and frequency domain are the most common. Aim of the research was to determine whether a new method of analyzing stabilographic measurements-the COP trend change analysis (TCI) of temporary posture corrections- can expand understanding of changes in balance strategy connected with PA. The study group involved 38 individuals (27women, 11men) aged 23±2.6 years. Measurements were performed using a stabilographic platform placed on a perturbation platform. The tests involved three measurements with forward and backward momentary movements of the platform. Participants were tested in three conditions-knowing the nature, time and direction of perturbation (Tr3), knowing only the nature of perturbation (Tr2) and without any information about the perturbation (Tr1). Statistically significant differences were revealed in the last second of Tr3 for the mean velocity of COP (p<0.05) and for two TCI parameters-TCI_dV (p<0.05) and TCI_dS (p<0.01). The increase in TCI_dV was related to the increase in the mean distance between trend changes (TCI_dS) and constant value of the mean time between trend changes (TCI_dT). The increase of the mean value of TCI_dS was the result of smaller number of posture corrections with the distance 0-2 mm and lager number with the distance 4-6 mm. Obtained results proved that the TCI analysis is a method enabling an extended analysis of PA, indicating the nature of changes occurring in posture corrections-longer momentary jumps of COP-related to a change in the strategy of maintaining balance before a known disorder, which has not been analyzed in this type of research so far.
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Affiliation(s)
- Piotr Wodarski
- Faculty of Biomedical Engineering, Department of Biomechatronics, Silesian University of Technology, Gliwice, Poland
| | - Marta Chmura
- Faculty of Biomedical Engineering, Department of Biomechatronics, Silesian University of Technology, Gliwice, Poland
| | - Michał Szlęzak
- Fizjosport Medical Center, Gliwice, Poland
- Association of Neurophysiological-Orthopaedic Manipulative Physical Therapists, Gliwice, Poland
| | - Grzegorz Bajor
- Department of Human Anatomy, Medical University of Silesia, Slaskie, Poland
| | - Marek Gzik
- Faculty of Biomedical Engineering, Department of Biomechatronics, Silesian University of Technology, Gliwice, Poland
| | - Jacek Jurkojć
- Faculty of Biomedical Engineering, Department of Biomechatronics, Silesian University of Technology, Gliwice, Poland
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Dalbah J, Zadeh SAM, Kim M. The Effect of a Cognitive Dual Task on Gait Parameters among Healthy Young Adults with Good and Poor Sleep Quality: A Cross-Sectional Analysis. J Clin Med 2024; 13:2566. [PMID: 38731095 PMCID: PMC11084228 DOI: 10.3390/jcm13092566] [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: 04/01/2024] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Sleep quality is known to affect automatic and executive brain functions such as gait control and cognitive processing. This study aimed to investigate the effect of dual tasks on gait spatiotemporal parameters among young adults with good and poor sleep quality. Methods: In total, 65 young adults with a mean age of 21.1 ± 2.5 were assessed for gait analysis during single-task and dual-task conditions. The participants' sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and gait was assessed using the BTS Gaitlab System. The participants were asked to walk at natural speed as a single-task condition, followed by walking while performing a cognitive task as a dual-task condition. The parameters assessed included the gait velocity (m/s), cadence (steps/min), step width (m), and stride length (m). The dual-task cost (DTC) on each gait parameter was calculated. The Mann-Whitney U test was used to compare the differences in the DTC on gait variables between the good and poor sleep quality groups and the Spearman correlation test was used to assess the correlation between total PSQI scores and the DTC. Results: At a significance level of p < 0.05, a significant difference in cadence between the two sleep quality groups was observed, in addition to a positive correlation between sleep quality and the DTC effect on gait mean velocity, cadence, and stride length. Our findings also revealed a greater DTC in participants with poorer sleep quality. Conclusions: These findings contribute to our perception of the significance of sleep quality in gait performance while multitasking in younger populations.
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Affiliation(s)
- Jood Dalbah
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates; (J.D.); (S.A.M.Z.)
| | - Shima A. Mohammad Zadeh
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates; (J.D.); (S.A.M.Z.)
| | - Meeyoung Kim
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates; (J.D.); (S.A.M.Z.)
- Laboratory of Health Science & Nanophysiotherapy, Department of Physical Therapy, Graduate School, Yongin University, Yongin 17092, Republic of Korea
- Neuromusculoskeletal Rehabilitation Research Group, Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
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Sánchez-González JL, Sanz-Esteban I, Menéndez-Pardiñas M, Navarro-López V, Sanz-Mengíbar JM. Critical review of the evidence for Vojta Therapy: a systematic review and meta-analysis. Front Neurol 2024; 15:1391448. [PMID: 38711552 PMCID: PMC11070493 DOI: 10.3389/fneur.2024.1391448] [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: 02/28/2024] [Accepted: 03/29/2024] [Indexed: 05/08/2024] Open
Abstract
Introduction It is essential to link the theoretical framework of any neurophysiotherapy approach with a detailed analysis of the central motor control mechanisms that influence motor behavior. Vojta therapy (VT) falls within interventions aiming to modify neuronal activity. Although it is often mistakenly perceived as exclusively pediatric, its utility spans various functional disorders by acting on central pattern modulation. This study aims to review the existing evidence on the effectiveness of VT across a wide range of conditions, both in the adult population and in pediatrics, and analyze common therapeutic mechanisms, focusing on motor control modulation. Aim The goals of this systematic review are to delineate the existing body of evidence concerning the efficacy of Vojta therapy (VT) in treating a broad range of conditions, as well as understand the common therapeutic mechanisms underlying VT with a specific focus on the neuromodulation of motor control parameters. Methods PubMed, Cochrane Library, SCOPUS, Web of Science, and Embase databases were searched for eligible studies. The methodological quality of the studies was assessed using the PEDro list and the Risk-Of-Bias Tool to assess the risk of bias in randomized trials. Methodological quality was evaluated using the Risk-Of-Bias Tool for randomized trials. Random-effects meta-analyses with 95% CI were used to quantify the change scores between the VT and control groups. The certainty of our findings (the closeness of the estimated effect to the true effect) was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). Results Fifty-five studies were included in the qualitative analysis and 18 in the meta-analysis. Significant differences in cortical activity (p = 0.0001) and muscle activity (p = 0.001) were observed in adults undergoing VT compared to the control, as well as in balance in those living with multiple sclerosis (p < 0.03). Non-significant differences were found in the meta-analysis when evaluating gross motor function, oxygen saturation, respiratory rate, height, and head circumference in pediatrics. Conclusion Although current evidence supporting VT is limited in quality, there are indications suggesting its potential usefulness for the treatment of respiratory, neurological, and orthopedic pathology. This systematic review and meta-analysis show the robustness of the neurophysiological mechanisms of VT, and that it could be an effective tool for the treatment of balance in adult neurological pathology. Neuromodulation of motor control areas has been confirmed by research focusing on the neurophysiological mechanisms underlying the therapeutic efficacy of VT.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=476848, CRD42023476848.
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Affiliation(s)
- Juan Luis Sánchez-González
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Ismael Sanz-Esteban
- Department of Physiotherapy, Physical Therapy and Health Sciences Research Group, Universidad Europea de Madrid, Madrid, Spain
| | - Mónica Menéndez-Pardiñas
- Early Intervention and Child Rehabilitation Department, Women & Children’s “Teresa Herrera Hospital”, A Coruña University Hospital (CHUAC), A Coruña, Spain
- Physiotherapy, Medicine and Biomedical Sciences Department, University of A Coruña, A Coruña, Spain
| | - Víctor Navarro-López
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Madrid, Spain
| | - José Manuel Sanz-Mengíbar
- Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, University College London Queen Square, London, United Kingdom
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Timm EC, Purcell NL, Ouyang B, Berry-Kravis E, Hall DA, O’Keefe JA. Potential Prodromal Digital Postural Sway Markers for Fragile X-Associated Tremor/Ataxia Syndrome (FXTAS) Detected via Dual-Tasking and Sensory Manipulation. SENSORS (BASEL, SWITZERLAND) 2024; 24:2586. [PMID: 38676203 PMCID: PMC11054629 DOI: 10.3390/s24082586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 03/27/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024]
Abstract
FXTAS is a neurodegenerative disorder occurring in some Fragile X Messenger Ribonucleoprotein 1 (FMR1) gene premutation carriers (PMCs) and is characterized by cerebellar ataxia, tremor, and cognitive deficits that negatively impact balance and gait and increase fall risk. Dual-tasking (DT) cognitive-motor paradigms and challenging balance conditions may have the capacity to reveal markers of FXTAS onset. Our objectives were to determine the impact of dual-tasking and sensory and stance manipulation on balance in FXTAS and potentially detect subtle postural sway deficits in FMR1 PMCs who are asymptomatic for signs of FXTAS on clinical exam. Participants with FXTAS, PMCs without FXTAS, and controls underwent balance testing using an inertial sensor system. Stance, vision, surface stability, and cognitive demand were manipulated in 30 s trials. FXTAS participants had significantly greater total sway area, jerk, and RMS sway than controls under almost all balance conditions but were most impaired in those requiring vestibular control. PMCs without FXTAS had significantly greater RMS sway compared with controls in the feet apart, firm, single task conditions both with eyes open and closed (EC) and the feet together, firm, EC, DT condition. Postural sway deficits in the RMS postural sway variability domain in asymptomatic PMCs might represent prodromal signs of FXTAS. This information may be useful in providing sensitive biomarkers of FXTAS onset and as quantitative balance measures in future interventional trials and longitudinal natural history studies.
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Affiliation(s)
- Emily C. Timm
- Department of Anatomy & Cell Biology, Rush University Medical Center, Chicago, IL 60612, USA; (E.C.T.); (E.B.-K.)
| | - Nicollette L. Purcell
- Department of Anatomy & Cell Biology, Rush University Medical Center, Chicago, IL 60612, USA; (E.C.T.); (E.B.-K.)
| | - Bichun Ouyang
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA; (B.O.); (D.A.H.)
| | - Elizabeth Berry-Kravis
- Department of Anatomy & Cell Biology, Rush University Medical Center, Chicago, IL 60612, USA; (E.C.T.); (E.B.-K.)
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA; (B.O.); (D.A.H.)
- Department of Pediatrics, Rush University Medical Center, Chicago, IL 60612, USA
| | - Deborah A. Hall
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA; (B.O.); (D.A.H.)
| | - Joan Ann O’Keefe
- Department of Anatomy & Cell Biology, Rush University Medical Center, Chicago, IL 60612, USA; (E.C.T.); (E.B.-K.)
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA; (B.O.); (D.A.H.)
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Krishnan C, Augenstein TE, Claflin ES, Hemsley CR, Washabaugh EP, Ranganathan R. Rest the Brain to Learn New Gait Patterns after Stroke. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.01.24304938. [PMID: 38633786 PMCID: PMC11023642 DOI: 10.1101/2024.04.01.24304938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Background The ability to relearn a lost skill is critical to motor recovery after a stroke. Previous studies indicate that stroke typically affects the processes underlying motor control and execution but not the learning of those skills. However, these prior studies could have been confounded by the presence of significant motor impairments and/or have not focused on motor acuity tasks (i.e., tasks focusing on the quality of executed actions) that have direct functional relevance to rehabilitation. Methods Twenty-five participants (10 stroke; 15 controls) were recruited for this prospective, case-control study. Participants learned a novel foot-trajectory tracking task on two consecutive days while walking on a treadmill. On day 1, participants learned a new gait pattern by performing a task that necessitated greater hip and knee flexion during the swing phase of the gait. On day 2, participants repeated the task with their training leg to test retention. An average tracking error was computed to determine online and offline learning and was compared between stroke survivors and uninjured controls. Results Stroke survivors were able to improve their tracking performance on the first day (p=0.033); however, the amount of learning in stroke survivors was lower in comparison with the control group on both days (p≤0.05). Interestingly, the offline gains in motor learning were higher in stroke survivors when compared with uninjured controls (p=0.011). Conclusions The results suggest that even high-functioning stroke survivors may have difficulty acquiring new motor skills related to walking, which may be related to the underlying neural damage caused at the time of stroke. Furthermore, it is likely that stroke survivors may require longer training with adequate rest to acquire new motor skills, and rehabilitation programs should target motor skill learning to improve outcomes after stroke.
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Affiliation(s)
- Chandramouli Krishnan
- Department of Physical Medicine and Rehabilitation, Michigan Medicine
- Department of Robotics, University of Michigan
- Department of Mechanical Engineering, University of Michigan
- School of Kinesiology, University of Michigan
- Biomedical Engineering, University of Michigan
- Department of Physical Therapy, University of Michigan-Flint
| | - Thomas E. Augenstein
- Department of Physical Medicine and Rehabilitation, Michigan Medicine
- Department of Robotics, University of Michigan
| | - Edward S. Claflin
- Department of Physical Medicine and Rehabilitation, Michigan Medicine
| | | | - Edward P. Washabaugh
- Department of Physical Medicine and Rehabilitation, Michigan Medicine
- Department of Biomedical Engineering, Wayne State University
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Čepukaitytė G, Newton C, Chan D. Early detection of diseases causing dementia using digital navigation and gait measures: A systematic review of evidence. Alzheimers Dement 2024; 20:3054-3073. [PMID: 38425234 PMCID: PMC11032572 DOI: 10.1002/alz.13716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/29/2023] [Accepted: 01/04/2024] [Indexed: 03/02/2024]
Abstract
Wearable digital technologies capable of measuring everyday behaviors could improve the early detection of dementia-causing diseases. We conducted two systematic reviews following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines to establish the evidence base for measuring navigation and gait, two everyday behaviors affected early in AD and non-AD disorders and not adequately measured in current practice. PubMed and Web of Science databases were searched for studies on asymptomatic and early-stage symptomatic individuals at risk of dementia, with the Newcastle-Ottawa Scale used to assess bias and evaluate methodological quality. Of 316 navigation and 2086 gait records identified, 27 and 83, respectively, were included in the final sample. We highlight several measures that may identify at-risk individuals, whose quantifiability with different devices mitigates the risk of future technological obsolescence. Beyond navigation and gait, this review also provides the framework for evaluating the evidence base for future digital measures of behaviors considered for early disease detection.
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Erdoğan MŞ, Arpak ES, Keles CSK, Villagra F, Işık EÖ, Afşar N, Yucesoy CA, Mur LAJ, Akanyeti O, Saybaşılı H. Biochemical, biomechanical and imaging biomarkers of ischemic stroke: Time for integrative thinking. Eur J Neurosci 2024; 59:1789-1818. [PMID: 38221768 DOI: 10.1111/ejn.16245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/12/2023] [Accepted: 12/16/2023] [Indexed: 01/16/2024]
Abstract
Stroke is one of the leading causes of adult disability affecting millions of people worldwide. Post-stroke cognitive and motor impairments diminish quality of life and functional independence. There is an increased risk of having a second stroke and developing secondary conditions with long-term social and economic impacts. With increasing number of stroke incidents, shortage of medical professionals and limited budgets, health services are struggling to provide a care that can break the vicious cycle of stroke. Effective post-stroke recovery hinges on holistic, integrative and personalized care starting from improved diagnosis and treatment in clinics to continuous rehabilitation and support in the community. To improve stroke care pathways, there have been growing efforts in discovering biomarkers that can provide valuable insights into the neural, physiological and biomechanical consequences of stroke and how patients respond to new interventions. In this review paper, we aim to summarize recent biomarker discovery research focusing on three modalities (brain imaging, blood sampling and gait assessments), look at some established and forthcoming biomarkers, and discuss their usefulness and complementarity within the context of comprehensive stroke care. We also emphasize the importance of biomarker guided personalized interventions to enhance stroke treatment and post-stroke recovery.
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Affiliation(s)
| | - Esra Sümer Arpak
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
| | - Cemre Su Kaya Keles
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
- Institute of Structural Mechanics and Dynamics in Aerospace Engineering, University of Stuttgart, Stuttgart, Germany
| | - Federico Villagra
- Department of Life Sciences, Aberystwyth University, Aberystwyth, Wales, UK
| | - Esin Öztürk Işık
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
| | - Nazire Afşar
- Neurology, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
| | - Can A Yucesoy
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
| | - Luis A J Mur
- Department of Life Sciences, Aberystwyth University, Aberystwyth, Wales, UK
| | - Otar Akanyeti
- Department of Computer Science, Llandinam Building, Aberystwyth University, Aberystwyth, UK
| | - Hale Saybaşılı
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
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Mao H, Xiao W, Hao Z, Wen S, Yang H, Sultan F, Wang C. Cerebellar Transcranial Direct Current Stimulation Modulates Anticipatory Postural Adjustments in Healthy Adults. CEREBELLUM (LONDON, ENGLAND) 2024; 23:383-390. [PMID: 36821023 PMCID: PMC10951010 DOI: 10.1007/s12311-023-01535-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 02/24/2023]
Abstract
During forward swinging of the arm, the central nervous system must anticipate the effect of upraising upon the body. Little is known about the cerebellar network that coordinates these anticipatory postural adjustments (APAs). Stimulating different cerebellar regions with transcranial direct current stimulation (tDCS) and with different polarities modulated the APAs. We used surface electromyography (sEMG) to measure muscle activities in a bilateral rapid shoulder flexion task. The onset of APAs was altered after tDCS over the vermis, while the postural stability and the kinematics of arm raising were not affected. To our knowledge, this is the first human cerebellar-tDCS (c-tDCS) study to separate cerebellar involvement in core muscle APAs in bilateral rapid shoulder flexion. These data contribute to our understanding of the cerebellar network supporting APAs in healthy adults. Modulated APAs of the erector spinae by tDCS on the vermis may be related to altered cerebellar brain inhibition (CBI), suggesting the importance of the vermal-cerebral connections in APAs regulation.
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Affiliation(s)
- Haian Mao
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Wenwu Xiao
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zengming Hao
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Shengjun Wen
- Department of Cognitive Neurology, Hertie Institute for Clinical Brain Research, Otfried-Müller Str. 27, 72076, Tübingen, Germany
| | - Huaichun Yang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Fahad Sultan
- Department of Integrative Medical Biology, Umeå University, Johan Bures Våg 12, 901 87, Umeå, Sweden
| | - Chuhuai Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
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Monoli C, Morris A, Crofts R, Fino NF, Petersell TL, Jameson T, Dibble LE, Fino PC. Acute and Longitudinal Effects of Sport-related Concussion on Reactive Balance. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.28.24305029. [PMID: 38585899 PMCID: PMC10996757 DOI: 10.1101/2024.03.28.24305029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Postural instability is a common observation after concussions, with balance assessments playing a crucial role in clinical evaluations. Widely used post-concussion balance tests focus primarily on static and dynamic balance, excluding the critical aspect of reactive balance. This study investigated the acute and longitudinal effects of concussion on reactive balance in collegiate athletes. The assessments were conducted at pre-season baseline and 4 post-concussion timepoints: acute, pre-return-to-play, post-return-to-play, and six months post-concussion. The instrumented-modified Push and Release test measured reactive balance. Longitudinal effects of concussions on time to stability and step latency metrics were investigated applying Generalized Estimating Equations. Acutely after concussion, athletes demonstrated impaired reactive balance, indicated by longer times to stability, in dual-task conditions ( p = 0.004). These acute impairments were transient and recovered over time. Exploratory analyses revealed that athletes who sustained their first lifetime concussion exhibited both acute ( p = 0.037) and longitudinal ( p = 0.004 at post-return-to-play) impairments in single- and dual-task compared to controls with no lifetime concussion. This comprehensive evaluation provides insights into the multifaceted nature of post-concussion impairments and emphasizes the importance of considering cognitive demand and history of concussions in assessing athletes' balance.
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Cavalcanti CCL, Manhães-de-Castro R, Chaves WF, Cadena-Burbano EV, Antonio-Santos J, da Silva Aragão R. Influence of maternal high-fat diet on offspring's locomotor activity during anxiety-related behavioral tests: A systematic review. Behav Brain Res 2024; 462:114869. [PMID: 38246396 DOI: 10.1016/j.bbr.2024.114869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 01/23/2024]
Abstract
The aim of this review was to summarize and discuss the impact of a maternal high-fat diet on the locomotor activity of offspring during anxiety-related behavioral tests. A search was performed in the LILACS, Web of Science, SCOPUS and PUMBED databases, using the following inclusion criteria: studies in which rodent dams were submitted to a high-fat diet during gestation and/or lactation and in which the locomotor activity parameters of offspring were evaluated during an anxiety-related test. Twenty-three articles met these criteria and were included. Most studies, 14 out of 23, found that a maternal high-fat diet did not alter offspring locomotor activity. Six articles found that a maternal high-fat diet increased the locomotor activity of offspring, while three found decreased locomotion. This effect may be associated with the initial response to the test and the fact that it was the first day of exposure to the apparatus.
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Affiliation(s)
| | - Raul Manhães-de-Castro
- Graduate Program in Neuropsychiatry and Behavioral Sciences, Universidade Federal de Pernambuco, 50670-901 PE, Brazil; Graduate Program in Nutrition, Universidade Federal de Pernambuco, 50670-901 Recife, PE, Brazil; Unit of Studies in Nutrition and Plasticity, Universidade Federal de Pernambuco, 50670-901 PE, Brazil
| | - Wenicios Ferreira Chaves
- Graduate Program in Nutrition, Sports Sciences and Metabolism, Universidade Estadual de Campinas, 13484-350 Campinas, SP, Brazil
| | | | - José Antonio-Santos
- Unit of Studies in Nutrition and Plasticity, Universidade Federal de Pernambuco, 50670-901 PE, Brazil; Physical Education and Sports Sciences Unit, Universidade Federal de Pernambuco, 55608-680 Vitória de Santo Antão, PE, Brazil
| | - Raquel da Silva Aragão
- Graduate Program in Nutrition, Universidade Federal de Pernambuco, 50670-901 Recife, PE, Brazil; Unit of Studies in Nutrition and Plasticity, Universidade Federal de Pernambuco, 50670-901 PE, Brazil; Physical Education and Sports Sciences Unit, Universidade Federal de Pernambuco, 55608-680 Vitória de Santo Antão, PE, Brazil.
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Penedo T, Kalva-Filho CA, Cursiol JA, Faria MH, Coelho DB, Barbieri FA. Spatial-temporal parameters during unobstructed walking in people with Parkinson's disease and healthy older people: a public data set. Front Aging Neurosci 2024; 16:1354738. [PMID: 38605861 PMCID: PMC11007149 DOI: 10.3389/fnagi.2024.1354738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/15/2024] [Indexed: 04/13/2024] Open
Affiliation(s)
- Tiago Penedo
- Human Movement Research Laboratory (MOVI-LAB), Department of Physical Education, São Paulo State University (Unesp), Bauru, Brazil
| | - Carlos Augusto Kalva-Filho
- Human Movement Research Laboratory (MOVI-LAB), Department of Physical Education, São Paulo State University (Unesp), Bauru, Brazil
| | - Jônatas Augusto Cursiol
- Human Movement Research Laboratory (MOVI-LAB), Department of Physical Education, São Paulo State University (Unesp), Bauru, Brazil
| | - Murilo Henrique Faria
- Human Movement Research Laboratory (MOVI-LAB), Department of Physical Education, São Paulo State University (Unesp), Bauru, Brazil
| | - Daniel Boari Coelho
- 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
| | - Fabio Augusto Barbieri
- Human Movement Research Laboratory (MOVI-LAB), Department of Physical Education, São Paulo State University (Unesp), Bauru, Brazil
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Farokhniaee A, Palmisano C, Del Vecchio Del Vecchio J, Pezzoli G, Volkmann J, Isaias IU. Gait-related beta-gamma phase amplitude coupling in the subthalamic nucleus of parkinsonian patients. Sci Rep 2024; 14:6674. [PMID: 38509158 PMCID: PMC10954750 DOI: 10.1038/s41598-024-57252-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 03/15/2024] [Indexed: 03/22/2024] Open
Abstract
Analysis of coupling between the phases and amplitudes of neural oscillations has gained increasing attention as an important mechanism for large-scale brain network dynamics. In Parkinson's disease (PD), preliminary evidence indicates abnormal beta-phase coupling to gamma-amplitude in different brain areas, including the subthalamic nucleus (STN). We analyzed bilateral STN local field potentials (LFPs) in eight subjects with PD chronically implanted with deep brain stimulation electrodes during upright quiet standing and unperturbed walking. Phase-amplitude coupling (PAC) was computed using the Kullback-Liebler method, based on the modulation index. Neurophysiological recordings were correlated with clinical and kinematic measurements and individual molecular brain imaging studies ([123I]FP-CIT and single-photon emission computed tomography). We showed a dopamine-related increase in subthalamic beta-gamma PAC from standing to walking. Patients with poor PAC modulation and low PAC during walking spent significantly more time in the stance and double support phase of the gait cycle. Our results provide new insights into the subthalamic contribution to human gait and suggest cross-frequency coupling as a gateway mechanism to convey patient-specific information of motor control for human locomotion.
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Affiliation(s)
- AmirAli Farokhniaee
- Fondazione Grigioni Per Il Morbo Di Parkinson, Via Gianfranco Zuretti 35, 20125, Milano, Italy.
- Parkinson Institute Milan, ASST G. Pini CTO, Via Bignami 1, 20126, Milano, Italy.
| | - Chiara Palmisano
- Department of Neurology, University Hospital of Würzburg, and Julius Maximilian University of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - Jasmin Del Vecchio Del Vecchio
- Department of Neurology, University Hospital of Würzburg, and Julius Maximilian University of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - Gianni Pezzoli
- Fondazione Grigioni Per Il Morbo Di Parkinson, Via Gianfranco Zuretti 35, 20125, Milano, Italy
- Parkinson Institute Milan, ASST G. Pini CTO, Via Bignami 1, 20126, Milano, Italy
| | - Jens Volkmann
- Department of Neurology, University Hospital of Würzburg, and Julius Maximilian University of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - Ioannis U Isaias
- Parkinson Institute Milan, ASST G. Pini CTO, Via Bignami 1, 20126, Milano, Italy
- Department of Neurology, University Hospital of Würzburg, and Julius Maximilian University of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
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Sigurdsson HP, Alcock L, Firbank M, Wilson R, Brown P, Maxwell R, Bennett E, Pavese N, Brooks DJ, Rochester L. Developing a novel dual-injection FDG-PET imaging methodology to study the functional neuroanatomy of gait. Neuroimage 2024; 288:120531. [PMID: 38331333 DOI: 10.1016/j.neuroimage.2024.120531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 01/26/2024] [Accepted: 02/05/2024] [Indexed: 02/10/2024] Open
Abstract
Gait is an excellent indicator of physical, emotional, and mental health. Previous studies have shown that gait impairments in ageing are common, but the neural basis of these impairments are unclear. Existing methodologies are suboptimal and novel paradigms capable of capturing neural activation related to real walking are needed. In this study, we used a hybrid PET/MR system and measured glucose metabolism related to both walking and standing with a dual-injection paradigm in a single study session. For this study, 15 healthy older adults (10 females, age range: 60.5-70.7 years) with normal cognition were recruited from the community. Each participant received an intravenous injection of [18F]-2-fluoro-2-deoxyglucose (FDG) before engaging in two distinct tasks, a static postural control task (standing) and a walking task. After each task, participants were imaged. To discern independent neural functions related to walking compared to standing, we applied a bespoke dose correction to remove the residual 18F signal of the first scan (PETSTAND) from the second scan (PETWALK) and proportional scaling to the global mean, cerebellum, or white matter (WM). Whole-brain differences in walking-elicited neural activity measured with FDG-PET were assessed using a one-sample t-test. In this study, we show that a dual-injection paradigm in healthy older adults is feasible with biologically valid findings. Our results with a dose correction and scaling to the global mean showed that walking, compared to standing, increased glucose consumption in the cuneus (Z = 7.03), the temporal gyrus (Z = 6.91) and the orbital frontal cortex (Z = 6.71). Subcortically, we observed increased glucose metabolism in the supraspinal locomotor network including the thalamus (Z = 6.55), cerebellar vermis and the brainstem (pedunculopontine/mesencephalic locomotor region). Exploratory analyses using proportional scaling to the cerebellum and WM returned similar findings. Here, we have established the feasibility and tolerability of a novel method capable of capturing neural activations related to actual walking and extended previous knowledge including the recruitment of brain regions involved in sensory processing. Our paradigm could be used to explore pathological alterations in various gait disorders.
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Affiliation(s)
- Hilmar P Sigurdsson
- Clinical Ageing Research Unit, Translational and Clinical Research Institute, Faculty of Medical Sciences, Campus for Aging and Vitality, Newcastle University, Newcastle Upon Tyne NE4 5PL, UK.
| | - Lisa Alcock
- Clinical Ageing Research Unit, Translational and Clinical Research Institute, Faculty of Medical Sciences, Campus for Aging and Vitality, Newcastle University, Newcastle Upon Tyne NE4 5PL, UK; National Institute for Health and Care Research (NIHR) Newcastle Biomedical Research Centre (BRC), Newcastle University and The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Michael Firbank
- Clinical Ageing Research Unit, Translational and Clinical Research Institute, Faculty of Medical Sciences, Campus for Aging and Vitality, Newcastle University, Newcastle Upon Tyne NE4 5PL, UK
| | - Ross Wilson
- Clinical Ageing Research Unit, Translational and Clinical Research Institute, Faculty of Medical Sciences, Campus for Aging and Vitality, Newcastle University, Newcastle Upon Tyne NE4 5PL, UK
| | - Philip Brown
- National Institute for Health and Care Research (NIHR) Newcastle Biomedical Research Centre (BRC), Newcastle University and The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ross Maxwell
- Clinical Ageing Research Unit, Translational and Clinical Research Institute, Faculty of Medical Sciences, Campus for Aging and Vitality, Newcastle University, Newcastle Upon Tyne NE4 5PL, UK
| | | | - Nicola Pavese
- Clinical Ageing Research Unit, Translational and Clinical Research Institute, Faculty of Medical Sciences, Campus for Aging and Vitality, Newcastle University, Newcastle Upon Tyne NE4 5PL, UK; Department of Nuclear Medicine and PET, Institute of Clinical Medicine, Aarhus University, Denmark
| | - David J Brooks
- Clinical Ageing Research Unit, Translational and Clinical Research Institute, Faculty of Medical Sciences, Campus for Aging and Vitality, Newcastle University, Newcastle Upon Tyne NE4 5PL, UK; Department of Nuclear Medicine and PET, Institute of Clinical Medicine, Aarhus University, Denmark
| | - Lynn Rochester
- Clinical Ageing Research Unit, Translational and Clinical Research Institute, Faculty of Medical Sciences, Campus for Aging and Vitality, Newcastle University, Newcastle Upon Tyne NE4 5PL, UK; National Institute for Health and Care Research (NIHR) Newcastle Biomedical Research Centre (BRC), Newcastle University and The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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40
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Wei X, Wang S, Zhang M, Yan Y, Wang Z, Wei W, Tuo H, Wang Z. Gait impairment-related axonal degeneration in Parkinson's disease by neurite orientation dispersion and density imaging. NPJ Parkinsons Dis 2024; 10:45. [PMID: 38413647 PMCID: PMC10899173 DOI: 10.1038/s41531-024-00654-w] [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: 07/06/2023] [Accepted: 02/06/2024] [Indexed: 02/29/2024] Open
Abstract
Microstructural alterations in the brain networks of Parkinson's disease (PD) patients are correlated with gait impairments. Evaluate microstructural alterations in the white matter (WM) fiber bundle tracts using neurite orientation dispersion and density imaging (NODDI) technique in PD versus healthy controls (HC). In this study, 24 PD patients and 29 HC were recruited. NODDI and high-resolution 3D structural images were acquired for each participant. The NODDI indicators, including the intracellular neurite density index (NDI), orientation dispersion index (ODI), and isotropic volume fraction (ISO), were compared between the two groups. Diffusion-weighted (DW) images were preprocessed using MRtrix 3.0 software and the orientation distribution function to trace the main nerve fiber tracts in PD patients. Quantitative gait and clinical assessment scales were used to compare the medication "ON" and "OFF" states of PD patients. The NDI, ODI, and ISO values of the WM fiber bundles were significantly higher in PD patients compared to HC. Fiber bundles, including the anterior thalamic radiation, corticospinal tract, superior longitudinal fasciculus, forceps major, cingulum, and inferior longitudinal fasciculus, were found to be significantly affected in PD. The NDI changes of PD patients were well correlated with stride lengths in the "ON" state; ODI changes were correlated with the stride time in the "ON" and "OFF" states and ISO changes were correlated with the stride time and cadence in the "ON" state. In conclusion, combination of NODDI technique and gait parameters can help detect gait impairment in PD patients early and accurately.
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Grants
- 82202097 National Natural Science Foundation of China (National Science Foundation of China)
- 82071257 National Natural Science Foundation of China (National Science Foundation of China)
- Beijing Scholars Program is the highest-level talent development program approved by the Beijing Municipal People’s Government. It aims to cultivate a group of scientists, engineers, and renowned experts who are at the forefront of global science and technology, possess innovative capabilities, and have international advanced levels. The program provides intellectual support for the construction of a globally influential science and technology innovation center.
- Beijing Hospitals Authority’ Youth Programme is one of the three major talent development programs, namely "Qingmiao, Dengfeng, Shiming," launched by the Beijing Hospital Management Center in 2015. This program aims to support and cultivate young talents and provide a development platform for the growth of young talents in municipal hospitals through various training initiatives. Training Fund for Open Projects at Clinical Institutes and Departments of Capital Medical University is a research support fund program for young doctors opened by Capital Medical University, targeting different specialties, colleges, and departments.
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Affiliation(s)
- Xuan Wei
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shiya Wang
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Mingkai Zhang
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ying Yan
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zheng Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wei Wei
- Division of Science and Technology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Houzhen Tuo
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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Nguyen TXD, Mai PT, Chang YJ, Hsieh TH. Effects of transcranial direct current stimulation alone and in combination with rehabilitation therapies on gait and balance among individuals with Parkinson's disease: a systematic review and meta-analysis. J Neuroeng Rehabil 2024; 21:27. [PMID: 38373966 PMCID: PMC10875882 DOI: 10.1186/s12984-024-01311-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 01/24/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Parkinson's disease (PD) is a neurogenerative disorder implicated in dysfunctions of motor functions, particularly gait and balance. Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation offered as a potential adjuvant therapy for PD. This systematic review and meta-analysis were conducted to identify whether tDCS alone and combined with additional rehabilitation therapies improve gait and balance among individuals with PD. METHODS We searched PubMed, Embase, Web of Science, and relevant databases for eligible studies from inception to December 2022. Studies with a comparative design investigating the effects of tDCS on motor functions, including gait and balance among individuals with PD, were included. A meta-analysis was performed for each outcome using a random effects model for subgroup analysis and pooling of overall effect sizes. RESULTS A total of 23 studies were included in the meta-analysis. The pooled results revealed that tDCS has moderate overall effects on gait, measured by gait speed (standardized mean deviation [SMD] = 0.238; 95% confidence interval [CI] - 0.026 to 0.502); stride length (SMD = 0.318; 95% CI - 0.015 to 0.652); cadence (SMD = - 0.632; 95% CI - 0.932 to - 0.333); freezing of gait questionnaire scores (SMD = - 0.360; 95% CI - 0.692 to - 0.027); step length (SMD = 0.459; 95% CI - 0.031 to 0.949); walking time (SMD = - 0.253; 95% CI - 0.758 to 0.252); stride time (SMD = - 0.785; 95% CI: - 1.680 to 0.111); double support time (SMD = 1.139; 95% CI - 0.244 to 0.523); and balance, measured by timed up and go (TUG) test (SMD = - 0.294; 95% CI - 0.516 to - 0.073), Berg balance scale (BBS) scores (SMD = 0.406; 95% CI - 0.059 to 0.87), and dynamic gait index (SMD = 0.275; 95% CI - 0.349 to 0.898). For the subgroup analysis, gait and balance demonstrated moderate effect sizes. However, only cadence, stride time, and TUG indicated a significant difference between real and sham tDCS (P = 0.027, P = 0.002, and P = 0.023, respectively), whereas cadence and BBS (P < 0.01 and P = 0.045, respectively) significantly differed after real tDCS plus other therapies rather than after sham tDCS plus other therapies. CONCLUSIONS Our results indicated that tDCS is significantly associated with gait and balance improvements among individuals with PD. The findings of this study provide more proof supporting the effectiveness of tDCS, encouraging tDCS to be utilized alone or in combination with other therapies in clinical practice for PD rehabilitation.
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Affiliation(s)
- Thi Xuan Dieu Nguyen
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Phuc Thi Mai
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ya-Ju Chang
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.
- Neuroscience Research Center, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan.
| | - Tsung-Hsun Hsieh
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.
- Neuroscience Research Center, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan.
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Silva-Batista C, Lira J, Coelho DB, de Lima-Pardini AC, Nucci MP, Mattos ECT, Magalhaes FH, Barbosa ER, Teixeira LA, Amaro Junior E, Ugrinowitsch C, Horak FB. Mesencephalic Locomotor Region and Presynaptic Inhibition during Anticipatory Postural Adjustments in People with Parkinson's Disease. Brain Sci 2024; 14:178. [PMID: 38391752 PMCID: PMC10887111 DOI: 10.3390/brainsci14020178] [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: 01/18/2024] [Revised: 02/11/2024] [Accepted: 02/13/2024] [Indexed: 02/24/2024] Open
Abstract
Individuals with Parkinson's disease (PD) and freezing of gait (FOG) have a loss of presynaptic inhibition (PSI) during anticipatory postural adjustments (APAs) for step initiation. The mesencephalic locomotor region (MLR) has connections to the reticulospinal tract that mediates inhibitory interneurons responsible for modulating PSI and APAs. Here, we hypothesized that MLR activity during step initiation would explain the loss of PSI during APAs for step initiation in FOG (freezers). Freezers (n = 34) were assessed in the ON-medication state. We assessed the beta of blood oxygenation level-dependent signal change of areas known to initiate and pace gait (e.g., MLR) during a functional magnetic resonance imaging protocol of an APA task. In addition, we assessed the PSI of the soleus muscle during APA for step initiation, and clinical (e.g., disease duration) and behavioral (e.g., FOG severity and APA amplitude for step initiation) variables. A linear multiple regression model showed that MLR activity (R2 = 0.32, p = 0.0006) and APA amplitude (R2 = 0.13, p = 0.0097) explained together 45% of the loss of PSI during step initiation in freezers. Decreased MLR activity during a simulated APA task is related to a higher loss of PSI during APA for step initiation. Deficits in central and spinal inhibitions during APA may be related to FOG pathophysiology.
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Affiliation(s)
- Carla Silva-Batista
- Exercise Neuroscience Research Group, University of São Paulo, São Paulo 05508-070, Brazil
- Department of Neurology, Oregon Health and Science University, Portland, OR 97239, USA
| | - Jumes Lira
- Exercise Neuroscience Research Group, University of São Paulo, São Paulo 05508-070, Brazil
- School of Arts, Sciences and Humanities, University of São Paulo, São Paulo 03828-000, Brazil
- School of Physical Education and Sport, University of São Paulo, São Paulo 05508-030, Brazil
| | - Daniel Boari Coelho
- Biomedical Engineering, Federal University of ABC, São Bernardo do Campo 09210-170, Brazil
| | | | | | | | | | - Egberto Reis Barbosa
- Movement Disorders Clinic, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05508-070, Brazil
| | - Luis Augusto Teixeira
- School of Physical Education and Sport, University of São Paulo, São Paulo 05508-030, Brazil
| | - Edson Amaro Junior
- Department of Radiology, University of São Paulo, São Paulo 05508-090, Brazil
| | - Carlos Ugrinowitsch
- School of Physical Education and Sport, University of São Paulo, São Paulo 05508-030, Brazil
| | - Fay B Horak
- Department of Neurology, Oregon Health and Science University, Portland, OR 97239, USA
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Alotaibi MM, Motl RW, Stavrinos D, Snyder SW, Singh H, Lein DH. Moderate-to-Vigorous Physical Activity and Response Inhibition Predict Balance in Adults with Attention Deficit/Hyperactivity Disorder. J Clin Med 2024; 13:968. [PMID: 38398282 PMCID: PMC10889301 DOI: 10.3390/jcm13040968] [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: 01/09/2024] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Background: Some evidence indicates that adults with attention deficit hyperactivity disorder (ADHD) may have balance impairments. This study examined the associations between moderate-to-vigorous physical activity (MVPA), response inhibition (RI), and static balance in this population while off and on psychostimulant medication (PS). Methods: Participants (n = 40; 30 females; M age = 29.0; SD = 6.3 years) wore an ActiGraph GT9X-link around their waist to estimate MVPA levels (minutes/day). To assess RI, participants completed the Delis-Kaplan Executive Function System (D-KEFS) subtests Trail-Making Test (TMT) and Color-Word Interference Test (CWIT). To evaluate static balance, participants completed postural sway area (cm2) assessments in four conditions: feet-apart eyes-open (FAEO), feet-apart eyes-closed (FAEC), feet-together eyes-open (FTEO), and feet-together eyes-closed (FTEC). Participants also completed the single-leg standing tests (seconds) with eyes open (SLEO) and with eyes closed (SLEC). Results: When off medication, MVPA significantly predicted SLEC (β = 0.30; p = 0.017). MVPA and TMT significantly predicted FTEO, explaining ~19% of the variance in FTEO; both MVPA and TMT were significant predictors (β = -0.33, p = 0.027 and β = -0.31, p = 0.039, respectively). When on medication, TMT significantly predicted FAEC (β = 0.17; p = 0.047). Conclusions: MVPA and RI may be effective parameters in predicting static balance in adults with ADHD when off medication only.
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Affiliation(s)
- Mansour M. Alotaibi
- Department of Rehabilitation, College of Medical Sciences, Northern Border University, Arar 73213, Saudi Arabia
- Center for Health Research, Northern Border University, Arar 73213, Saudi Arabia
| | - Robert W. Motl
- Department of Kinesiology and Nutrition, University of Illinois, Chicago, IL 61820, USA;
| | - Despina Stavrinos
- Department of Psychology, University of Alabama, Tuscaloosa, AL 35487, USA;
| | - Scott W. Snyder
- Department of Human Studies, University of Alabama at Birmingham, Birmingham, AL 35233, USA;
| | - Harshvardhan Singh
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL 35233, USA; (H.S.); (D.H.L.J.)
| | - Donald H. Lein
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL 35233, USA; (H.S.); (D.H.L.J.)
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Cano LA, Albarracín AL, Pizá AG, García-Cena CE, Fernández-Jover E, Farfán FD. Assessing Cognitive Workload in Motor Decision-Making through Functional Connectivity Analysis: Towards Early Detection and Monitoring of Neurodegenerative Diseases. SENSORS (BASEL, SWITZERLAND) 2024; 24:1089. [PMID: 38400247 PMCID: PMC10893317 DOI: 10.3390/s24041089] [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: 07/24/2023] [Revised: 09/04/2023] [Accepted: 02/05/2024] [Indexed: 02/25/2024]
Abstract
Neurodegenerative diseases (NDs), such as Alzheimer's, Parkinson's, amyotrophic lateral sclerosis, and frontotemporal dementia, among others, are increasingly prevalent in the global population. The clinical diagnosis of these NDs is based on the detection and characterization of motor and non-motor symptoms. However, when these diagnoses are made, the subjects are often in advanced stages where neuromuscular alterations are frequently irreversible. In this context, we propose a methodology to evaluate the cognitive workload (CWL) of motor tasks involving decision-making processes. CWL is a concept widely used to address the balance between task demand and the subject's available resources to complete that task. In this study, multiple models for motor planning during a motor decision-making task were developed by recording EEG and EMG signals in n=17 healthy volunteers (9 males, 8 females, age 28.66±8.8 years). In the proposed test, volunteers have to make decisions about which hand should be moved based on the onset of a visual stimulus. We computed functional connectivity between the cortex and muscles, as well as among muscles using both corticomuscular and intermuscular coherence. Despite three models being generated, just one of them had strong performance. The results showed two types of motor decision-making processes depending on the hand to move. Moreover, the central processing of decision-making for the left hand movement can be accurately estimated using behavioral measures such as planning time combined with peripheral recordings like EMG signals. The models provided in this study could be considered as a methodological foundation to detect neuromuscular alterations in asymptomatic patients, as well as to monitor the process of a degenerative disease.
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Affiliation(s)
- Leonardo Ariel Cano
- Neuroscience and Applied Technologies Laboratory (LINTEC), Bioengineering Department, Faculty of Exact Sciences and Technology (FACET), National University of Tucuman, Superior Institute of Biological Research (INSIBIO), National Scientific and Technical Research Council (CONICET), Av. Independencia 1800, San Miguel de Tucuman 4000, Argentina
| | - Ana Lía Albarracín
- Neuroscience and Applied Technologies Laboratory (LINTEC), Bioengineering Department, Faculty of Exact Sciences and Technology (FACET), National University of Tucuman, Superior Institute of Biological Research (INSIBIO), National Scientific and Technical Research Council (CONICET), Av. Independencia 1800, San Miguel de Tucuman 4000, Argentina
| | - Alvaro Gabriel Pizá
- Neuroscience and Applied Technologies Laboratory (LINTEC), Bioengineering Department, Faculty of Exact Sciences and Technology (FACET), National University of Tucuman, Superior Institute of Biological Research (INSIBIO), National Scientific and Technical Research Council (CONICET), Av. Independencia 1800, San Miguel de Tucuman 4000, Argentina
| | - Cecilia Elisabet García-Cena
- ETSIDI-Center for Automation and Robotics, Universidad Politécnica de Madrid, Ronda de Valencia 3, 28012 Madrid, Spain
| | - Eduardo Fernández-Jover
- Institute of Bioengineering, Universidad Miguel Hernández of Elche, 03202 Elche, Spain
- Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, Spain
| | - Fernando Daniel Farfán
- Neuroscience and Applied Technologies Laboratory (LINTEC), Bioengineering Department, Faculty of Exact Sciences and Technology (FACET), National University of Tucuman, Superior Institute of Biological Research (INSIBIO), National Scientific and Technical Research Council (CONICET), Av. Independencia 1800, San Miguel de Tucuman 4000, Argentina
- Institute of Bioengineering, Universidad Miguel Hernández of Elche, 03202 Elche, Spain
- Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, Spain
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Arin-Bal G, Livanelioglu A, Leardini A, Belvedere C. Correlations between plantar pressure and postural balance in healthy subjects and their comparison according to gender and limb dominance: A cross-sectional descriptive study. Gait Posture 2024; 108:124-131. [PMID: 38039867 DOI: 10.1016/j.gaitpost.2023.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/07/2023] [Accepted: 11/22/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Lower extremity injuries rank among the most common injuries affecting young population, and numerous factors affect the outcomes of plantar pressure and balance assessment. RESEARCH QUESTION Does a correlation exist between plantar pressure and postural balance in healthy subjects and are there any difference in the results based on gender and limb dominance? METHODS This study involved thirty healthy recreationally active young adults (15 females, 15 males). Plantar pressures were analyzed using the MatScan Pressure Mat System, and postural balance was evaluated using Biodex Balance System. All assessments conducted under both static and dynamic conditions. Correlations were tested by Spearman Correlation Coefficient, and comparative tests were performed for gender and limb dominance. RESULTS Correlations were observed between plantar pressure parameters and balance scores, particularly in the dynamic conditions (p < 0.05). Gender-based differences were noted in plantar pressure parameters (p < 0.05), with females demonstrating improved balance stability scores. No significant differences were found based on limb dominance in plantar pressure and postural balance data (p > 0.05). SIGNIFICANCE This study provides valuable detailed insights into the existing literature concerning plantar pressure and postural balance assessments within the healthy population. A strong correlation was observed between plantar pressure and postural balance, and the comparisons of these assessments were affected by gender but not by limb dominance. These results could lead the way for better rehabilitation approaches by considering the correlations and differences across diverse populations.
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Affiliation(s)
- Gamze Arin-Bal
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey.
| | - Ayse Livanelioglu
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Desmons M, Cherif A, Rohel A, de Oliveira FCL, Mercier C, Massé-Alarie H. Corticomotor Control of Lumbar Erector Spinae in Postural and Voluntary Tasks: The Influence of Transcranial Magnetic Stimulation Current Direction. eNeuro 2024; 11:ENEURO.0454-22.2023. [PMID: 38167617 PMCID: PMC10883751 DOI: 10.1523/eneuro.0454-22.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/30/2023] [Accepted: 12/16/2023] [Indexed: 01/05/2024] Open
Abstract
Lumbar erector spinae (LES) contribute to spine postural and voluntary control. Transcranial magnetic stimulation (TMS) preferentially depolarizes different neural circuits depending on the direction of electrical currents evoked in the brain. Posteroanterior current (PA-TMS) and anteroposterior (AP-TMS) current would, respectively, depolarize neurons in the primary motor cortex (M1) and the premotor cortex. These regions may contribute differently to LES control. This study examined whether responses evoked by PA- and AP-TMS are different during the preparation and execution of LES voluntary and postural tasks. Participants performed a reaction time task. A Warning signal indicated to prepare to flex shoulders (postural; n = 15) or to tilt the pelvis (voluntary; n = 13) at the Go signal. Single- and paired-pulse TMS (short-interval intracortical inhibition-SICI) were applied using PA- and AP-TMS before the Warning signal (baseline), between the Warning and Go signals (preparation), or 30 ms before the LES onset (execution). Changes from baseline during preparation and execution were calculated in AP/PA-TMS. In the postural task, MEP amplitude was higher during the execution than that during preparation independently of the current direction (p = 0.0002). In the voluntary task, AP-MEP amplitude was higher during execution than that during preparation (p = 0.016). More PA inhibition (SICI) was observed in execution than that in preparation (p = 0.028). Different neural circuits are preferentially involved in the two motor tasks assessed, as suggested by different patterns of change in execution of the voluntary task (AP-TMS, increase; PA-TMS, no change). Considering that PA-TMS preferentially depolarize neurons in M1, it questions their importance in LES voluntary control.
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Affiliation(s)
- Mikaël Desmons
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), CIUSSS de la Capitale-Nationale, Quebec City, Quebec G1M 2S8, Canada
- Rehabilitation Department, University Laval, Quebec City, Quebec G1V 0A6, Canada, G1V 0A6
| | - Amira Cherif
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), CIUSSS de la Capitale-Nationale, Quebec City, Quebec G1M 2S8, Canada
- Rehabilitation Department, University Laval, Quebec City, Quebec G1V 0A6, Canada, G1V 0A6
| | - Antoine Rohel
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), CIUSSS de la Capitale-Nationale, Quebec City, Quebec G1M 2S8, Canada
- Rehabilitation Department, University Laval, Quebec City, Quebec G1V 0A6, Canada, G1V 0A6
| | - Fábio Carlos Lucas de Oliveira
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), CIUSSS de la Capitale-Nationale, Quebec City, Quebec G1M 2S8, Canada
- Rehabilitation Department, University Laval, Quebec City, Quebec G1V 0A6, Canada, G1V 0A6
| | - Catherine Mercier
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), CIUSSS de la Capitale-Nationale, Quebec City, Quebec G1M 2S8, Canada
- Rehabilitation Department, University Laval, Quebec City, Quebec G1V 0A6, Canada, G1V 0A6
| | - Hugo Massé-Alarie
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), CIUSSS de la Capitale-Nationale, Quebec City, Quebec G1M 2S8, Canada
- Rehabilitation Department, University Laval, Quebec City, Quebec G1V 0A6, Canada, G1V 0A6
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Lheureux A, Lejeune T, Doncev I, Jeanne A, Stoquart G. Comparison of the effects of rhythmic vibrotactile stimulations and rhythmic auditory stimulations on Parkinson's disease patients' gait variability: a pilot study. Acta Neurol Belg 2024; 124:161-168. [PMID: 37597161 DOI: 10.1007/s13760-023-02360-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/09/2023] [Indexed: 08/21/2023]
Abstract
INTRODUCTION Parkinson's disease patients' gait is characterized by shorter step length, reduced gait velocity and deterioration of temporal organization of stride duration variability (modified Long Range Autocorrelations). The objective of this study was to compare effects of rhythmic auditory stimulations (RAS) and Rhythmic Vibrotactile Stimulations (RVS) on Parkinson's disease patients' gait. METHODS Ten Parkinson's disease patients performed three walking conditions lasting 5-7 min each: control condition (CC), RAS condition and RVS condition. Inertial measurement units were used to assess spatiotemporal gait parameters. Stride duration variability was assessed in terms of magnitude using coefficient of variation and in terms of temporal organization (i.e., Long Range Autocorrelations computation) using the evenly spaced averaged Detrended Fluctuation Analysis (α-DFA exponent). RESULTS Gait velocity was significantly higher during RAS condition than during CC (Cohen's d = 0.52) and similar to RVS condition (Cohen's d = 0.17). Cadence was significantly higher during RAS (Cohen's d = 0.77) and RVS (Cohens' d = 0.56) conditions than during CC. Concerning variability, no difference was found either for mean coefficient of variation or mean α-DFA between conditions. However, a great variability of individual results between the RAS and the RVS conditions is to be noted concerning α-DFA. CONCLUSIONS RAS and RVS improved similarly PD patients' spatiotemporal gait parameters, without modifying stride duration variability in terms of magnitude and temporal organization at group level. Future studies should evaluate the relevant parameters for administering the right cueing type for the right patient. TRIAL REGISTRATION ClinicalTrial.gov registration number NCT05790759, date of registration: 16/03/2023, retrospectively registered.
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Affiliation(s)
- Alexis Lheureux
- Cliniques Universitaires Saint-Luc, Brussels, Belgium.
- Université Catholique de Louvain, Louvain-La-Neuve, Belgium.
| | - Thierry Lejeune
- Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Université Catholique de Louvain, Louvain-La-Neuve, Belgium
| | - Ivan Doncev
- Université Catholique de Louvain, Louvain-La-Neuve, Belgium
| | - Alix Jeanne
- Université Catholique de Louvain, Louvain-La-Neuve, Belgium
| | - Gaëtan Stoquart
- Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Université Catholique de Louvain, Louvain-La-Neuve, Belgium
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48
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Silva RM, Orsatti FL, Margato LR, de Sousa WG, Pelet DCS, Justino da Silva JL, de Sousa Lino AD, de Oliveira Assumpção C, Souza MVC. The relationship between depressive symptoms and physical performance in postmenopausal women: a cross-sectional investigation. Menopause 2024; 31:101-107. [PMID: 38113407 DOI: 10.1097/gme.0000000000002300] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
OBJECTIVE The relationship between depressive symptoms and declining physical performance in postmenopausal women has been extensively examined. However, various confounding factors can influence this association. This study aimed to investigate the link between depressive symptoms and physical performance in postmenopausal women while considering potential interfering factors. METHODS In this cross-sectional study, 137 postmenopausal women were categorized into two groups based on the presence of depressive symptoms (n = 58; mean ± SD age, 60.12 ± 8.45 y) and absence of depressive symptoms (n = 79; mean ± SD age, 60.72 ± 7.45) using the Geriatric Depression Scale (short version) (GDS-15). Thoracic kyphosis angle was measured using the flexicurve method. Physical performance was assessed through various tests, including Timed Up and Go, Five Times Stand and Sit Test, 6-minute Walking Speed, 10-meter Usual Walking Speed, 10-meter Fast Walking Speed, and dynamometry. The study compared variables between the two groups and used linear regression models adjusted for dynamometry, kyphosis angle, age, antidepressant usage, sitting time, and fall history to evaluate the relationship between GDS-15 scores and physical performance. RESULTS Significant differences were observed in physical performance, body mass index, kyphosis angle, antidepressant usage, sitting time, and fall history between women with and without depressive symptoms. The GDS-15 showed a negative association with all walking speed tests (10-meter Usual Walking Speed, m/s; P < 0.001; B = -0.01; 10-meter Fast Walking Speed, m/s; P < 0.001; B = -0.02; 6-minute Walking Speed, m/s; P < 0.004; B = -0.01) and a positive association with the Five Times Stand and Sit Test ( P < 0.002; B = 0.21) and Timed Up and Go ( P < 0.001; B = 0.13) tests, regardless of grip strength, kyphosis angle, age, antidepressant use, sitting time, or fall history in postmenopausal women. CONCLUSIONS This study underscores the independent and substantial impact of depressive symptoms on the physical performance of postmenopausal women. These findings emphasize the importance of addressing both mental health and physical well-being when providing care and support for this demographic.
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Affiliation(s)
- Rosely M Silva
- From the Applied Physiology Nutrition and Exercise Research Group, Exercise Biology and Aging Laboratory (BioEx), Federal University of Triangulo Mineiro, Uberaba, Minas Gerais, Brazil
| | | | - Luana R Margato
- From the Applied Physiology Nutrition and Exercise Research Group, Exercise Biology and Aging Laboratory (BioEx), Federal University of Triangulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Wellington G de Sousa
- From the Applied Physiology Nutrition and Exercise Research Group, Exercise Biology and Aging Laboratory (BioEx), Federal University of Triangulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Danyelle C S Pelet
- From the Applied Physiology Nutrition and Exercise Research Group, Exercise Biology and Aging Laboratory (BioEx), Federal University of Triangulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Jonathã Luiz Justino da Silva
- From the Applied Physiology Nutrition and Exercise Research Group, Exercise Biology and Aging Laboratory (BioEx), Federal University of Triangulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Anderson D de Sousa Lino
- From the Applied Physiology Nutrition and Exercise Research Group, Exercise Biology and Aging Laboratory (BioEx), Federal University of Triangulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Cláudio de Oliveira Assumpção
- From the Applied Physiology Nutrition and Exercise Research Group, Exercise Biology and Aging Laboratory (BioEx), Federal University of Triangulo Mineiro, Uberaba, Minas Gerais, Brazil
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49
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Park J, Lee C, Nam YE, Lee H. Association between depressive symptoms and dynamic balance among young adults in the community. Heliyon 2024; 10:e24093. [PMID: 38293335 PMCID: PMC10826134 DOI: 10.1016/j.heliyon.2024.e24093] [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: 06/26/2023] [Revised: 12/11/2023] [Accepted: 01/03/2024] [Indexed: 02/01/2024] Open
Abstract
Background Detecting and addressing depression symptoms at their outset can reduce the burden on individuals and society; however, it has a limitation in that such evaluations mainly rely on self-reports. Several studies have demonstrated a strong association between motor symptoms and early depression. We aimed to associate body balance measured by the Lower Quarter Y Balance Test (YBT-LQ) with depressive symptoms among young adults in the community, to confirm the current evidence that depression negatively influences body balance. Research question Is the YBT-LQ an objective tool for measuring and evaluating young adults' depression risks, as well as assessing whether depression negatively influences body balance? Methods Our participants comprised 36 young adults. We assessed their depressive symptoms using the Center for Epidemiological Studies Depression Scale (CES-D) via a Google survey, measured their body balance with the YBT-LQ, and analyzed data with Spearman's rank-order correlation coefficient test, using SPSS version 27.0. Results We found that the right leg's anterior, posteromedial, and posterolateral scores- Z = -2.129, p = .033; Z = -2.181, p = .029; and Z = -2.250, p = .024, respectively-and composite scores-Z = 73.00, p = .027 -were significantly lower in the group with risk for clinical depression compared to the normal group. The CES-D total score had a negative association with all YBT-LQ scores, except for the anterior score of the left leg. Among the CES-D sub-factors, somatic and retarded activity showed negative correlations with all the YBT-LQ scores. Significance Our findings revealed that depressive symptoms have a negative association with balance, and that the YBT-LQ can be a reliable tool for measuring motor symptoms of depression, specifically among young adults.
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Affiliation(s)
- Jinyoung Park
- College of Nursing, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Cynthia Lee
- School of Integrated Health Sciences, University of Nevada, Las Vegas (UNLV), 4505 S. Maryland Pkwy, Las Vegas, NV, 89154, USA
| | - Ye Eun Nam
- Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas (UNLV), 625 Shadow Ln, Las Vegas, NV, 89128, USA
| | - Hyunhwa Lee
- School of Nursing, University of Nevada, Las Vegas (UNLV), 4505 S. Maryland Pkwy., Las Vegas, NV, 89154, USA
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50
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Ebihara A, Hirota M, Kumakura Y, Nagaoka M. Analysis of muscle synergy and gait kinematics during regain of gait function through rehabilitation in a monoplegic patient. Front Hum Neurosci 2024; 17:1287675. [PMID: 38264349 PMCID: PMC10803437 DOI: 10.3389/fnhum.2023.1287675] [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: 09/02/2023] [Accepted: 11/29/2023] [Indexed: 01/25/2024] Open
Abstract
Purpose We conducted muscle synergy and gait analyses in a monoplegic patient whose gait function improved through training, to explore the possibility of using these parameters as indicators of training. Case presentation A 49-year-old male had monoplegia of the right lower limb caused by infarction of the left paracentral lobule. After 2 months of training, he was able to walk and returned to work. Methods Consecutive analyses were done after admission. Muscle synergy analysis: during walking, surface electromyograms of gluteus maximus, quadriceps femoris, adductor femoris, hamstrings, tibialis anterior, medial/lateral gastrocnemius, and soleus on both sides were recorded and processed for non-negative matrix factorization (NNMF) analysis. Gait analysis: markers were placed at foot, and walking movements were video recorded as changes in position of the markers. Results Compared with three muscle synergies detected on the non-paretic side, two muscle synergies were extracted on the paretic side at admission, and the number increased to three and then four with progress in rehabilitation training. Changes in weighting and activity of the muscle synergies were greater on the non-paretic side than on the paretic side. With training, the knee joint flexor and the ankle dorsiflexor activities on the paretic side and the gluteus maximus activity on the non-paretic side increased during swing phase as shown by weight changes of muscle synergies, and gait analysis showed increased knee joint flexion and ankle joint dorsiflexion during swing phase in the paretic limb. On the non-paretic side, however, variability of muscle activity was observed, and three or four muscle synergies were extracted depending on the number of strides analyzed. Conclusion The number of muscle synergies is considered to contribute to motor control. Rehabilitation training improves gait by increasing the number of muscle synergies on the paretic side and changing the weights of the muscles constituting the muscle synergies. From the changes on the non-paretic side, we propose the existence of compensatory mechanisms also on the non-paretic side. In muscle synergy analysis, in addition to the filters, the number of strides used in each analysis set has to be examined. This report highlights the issues of NNMF as analytical methods in gait training for stroke patients.
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Affiliation(s)
- Akira Ebihara
- Department of Rehabilitation, Tsubasa-no-ie Hospital, Oyama, Tochigi, Japan
| | - Mitsuki Hirota
- Department of Rehabilitation, Tsubasa-no-ie Hospital, Oyama, Tochigi, Japan
- Department of Rehabilitation Medicine, Dokkyo Medical University, Shimotsugagun, Tochigi, Japan
| | - Yasuhiro Kumakura
- Division of Rehabilitation Services, Tsubasa-no-ie Hospital, Oyama, Tochigi, Japan
| | - Masanori Nagaoka
- Department of Rehabilitation, Tsubasa-no-ie Hospital, Oyama, Tochigi, Japan
- Department of Neurology and Rehabilitation, Graduate School of Medicine, Juntendo University, Tokyo, Japan
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