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Kazemi D, Chadeganipour AS, Dehghani M, Ghorbali F. Associations of dual-task walking costs with cognition in Parkinson's disease. Gait Posture 2024; 110:48-52. [PMID: 38484647 DOI: 10.1016/j.gaitpost.2024.03.002] [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: 05/05/2023] [Revised: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Gait and cognition are closely associated in Parkinson's disease (PD), with specific cognitive domains being associated with different motor symptoms. By identifying gait parameters affected by cognition, clinicians can develop targeted interventions that address cognitive impairment, improve gait, and reduce the risk of injury in PD patients. RESEARCH QUESTION What gait parameters are affected by cognition in PD patients during dual-task walking, and how are these parameters related to cognitive function as measured by the Montreal Cognitive Assessment (MoCA)? METHODS 36 patients with available gait data and cognitive assessments were enrolled. Gait data of usual and dual-task walking sessions were recorded using lightweight wireless wearable sensors attached to trunk, lower, and upper extremities. Dual-task costs were calculated from usual and dual-task measures. Statistical analysis included non-parametric tests, Wilcoxon signed-rank test, Spearman's correlation, and stepwise linear regression models. RESULTS Walking speed, cadence, asymmetry in arm swing (ASA), between arms' amplitude symmetry (BAS), average stride time, and jerk of the acceleration movement of the legs were found to be affected during the dual-task walking session (P<0.05). Spearman's correlation showed significant correlations between MoCA scores and ASA (ρ=-0.469, P=0.036) and BAS (ρ=-0.448, P=0.036) costs. Stepwise linear regression models found that MoCA scores were significant predictors of BAS and ASA costs (P<0.05). SIGNIFICANCE This study found a significant association between global cognitive ability and several gait parameters costs under cognitive load caused by dual-task walking in PD patients. The study identified the gait parameters that were affected by cognitive load and found that MoCA scores were significant predictors of those gait parameters. Identifying gait parameters affected by cognition can lead to more targeted interventions for improving gait and reducing injury risk in PD patients.
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Affiliation(s)
- Danial Kazemi
- Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Mina Dehghani
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Ghorbali
- Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
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Tsai SY, Tai CH, Lee YY. Exploring Potential Predictors of Treadmill Training Effects in People With Parkinson Disease. Arch Phys Med Rehabil 2024; 105:525-530. [PMID: 37757940 DOI: 10.1016/j.apmr.2023.09.008] [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: 02/16/2023] [Revised: 06/30/2023] [Accepted: 09/10/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVE To explore the potential predictors of people with Parkinson disease (PD) who would benefit the most from treadmill training. DESIGN A cohort study. SETTING Medical university rehabilitation settings. PARTICIPANTS Seventy participants diagnosed of idiopathic PD. INTERVENTIONS Twelve sessions of treadmill training. MAIN OUTCOME MEASURES Hierarchical logistic regression models were used to explore significant predictors of the treadmill training effect with respect to 3 health domains: Unified Parkinson's Disease Rating Scales part III (UPDRS III); gait speed; Parkinson's Disease Questionnaire-39 (PDQ-39). A receiver operating characteristic (ROC) curve analysis was conducted to identify proper cut-off points for clinical use. RESULTS Male sex (adjusted odds ratio [OR]: 3.73, P=.036) significantly predicted the improvement of UPDRS III. Individuals with a slower baseline gait speed (cut-off: 0.92 m/s, adjusted OR: 14.06, P<.001) and higher baseline balance confidence measured by the Activity-specific Balance Confidence scale (cut-off: 84.5 points, adjusted OR: 4.66, P=.022) have greater potential to achieve clinically relevant improvements in gait speed. A poorer baseline PDQ-39 score (cut-off: 23.1, adjusted OR: 7.47, P<.001) predicted a greater quality of life improvement after treadmill training. CONCLUSIONS These findings provide a guideline for clinicians to easily identify suitable candidates for treadmill training. Generalization to more advanced patients with PD warrants further investigation.
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Affiliation(s)
- Si-Yu Tsai
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chun-Hwei Tai
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ya-Yun Lee
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Amin RM, Phillips JJ, Humbert AT, Cholerton BA, Short VD, Smith MJ, Zabetian CP, Mata IF, Kelly VE. Associations between baseline cognitive status and motor outcomes after treadmill training in people with Parkinson's disease: a pilot study. Disabil Rehabil 2024; 46:1082-1091. [PMID: 37010072 PMCID: PMC10545807 DOI: 10.1080/09638288.2023.2189318] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/27/2023] [Accepted: 03/05/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE To determine the effect of baseline cognition on gait outcomes after a treadmill training program for people with Parkinson's disease (PD). METHODS This pilot clinical trial involved people with PD who were classified as having no cognitive impairment (PD-NCI) or mild cognitive impairment (PD-MCI). Baseline executive function and memory were assessed. The intervention was a 10-week gait training program (twice-weekly treadmill sessions), with structured speed and distance progression and verbal cues for gait quality. Response to intervention was assessed by gait speed measured after week 2 (short-term) and week 10 (long-term). RESULTS Participants (n = 19; 12 PD-NCI, 7 PD-MCI) had a mean (standard deviation) age of 66.5 (6.3) years, disease duration of 8.8 (6.3) years, and MDS-UPDRS III score of 21.3 (10.7). Gait speed increased at short-term and long-term assessments. The response did not differ between PD-NCI and PD-MCI groups; however, better baseline memory performance and milder PD motor severity were independently associated with greater improvements in gait speed in unadjusted and adjusted models. CONCLUSIONS These findings suggest that memory impairments and more severe motor involvement can influence the response to gait rehabilitation in PD and highlight the need for treatments optimized for people with greater cognitive and motor impairment.IMPLICATIONS FOR REHABILITATIONCognitive deficits in Parkinson's disease (PD) could impact motor learning and gait rehabilitation, yet little is known about the effects of cognitive impairments on the response to rehabilitation in people with PD.This study demonstrates that the response to gait rehabilitation did not differ between people with PD who had no cognitive impairment and those with mild cognitive impairment.Across all participants, better baseline memory was associated with greater improvements in gait speed.Rehabilitation professionals should be mindful of PD severity, as those with more substantial memory and motor impairments may require additional dosing or support to maximize gait training benefits.
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Affiliation(s)
- Raima M. Amin
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
- Department of Neurology, University of Washington, Seattle, WA, USA
| | | | - Andrew T. Humbert
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Brenna A. Cholerton
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Valerie D. Short
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Melissa J. Smith
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Cyrus P. Zabetian
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
- Department of Neurology, University of Washington, Seattle, WA, USA
| | - Ignacio F. Mata
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
- Department of Neurology, University of Washington, Seattle, WA, USA
- Lerner Research Institute, Genomic Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Valerie E. Kelly
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
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Zhang M, Gan Y, Wang X, Wang Z, Feng T, Zhang Y. Gait performance and non-motor symptoms burden during dual-task condition in Parkinson's disease. Neurol Sci 2023; 44:181-190. [PMID: 36125574 DOI: 10.1007/s10072-022-06411-2] [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: 07/03/2022] [Accepted: 09/13/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Impaired gait is observed in patients with Parkinson's disease (PD) in both single-task (ST) and dual-task (DT) conditions. Non-motor symptoms (NMSs), another vital symptom future experienced along the PD disease trajectory, contribute to gait performance in PD. However, whether DT gait performance is indicative of NMS burden (NMSB) remains unknown. This study investigated correlation between NMS and DT gait performance and whether NMSB is reflected in the DT effects (DTEs) of gait parameters in PD. METHODS Thirty-three idiopathic PD participants were enrolled in this study; the median H-Y staging was 2.5. NMSB was assessed by Non-motor Symptoms Scale (NMSS). Spatiotemporal gait parameters under ST and DT conditions were evaluated by wearable sensors. Gait parameters under ST and DT conditions and DTEs of gait parameters were compared across NMSB groups. The associations between NMS and DTEs of gait parameters were analyzed by correlation analysis and linear regression models. RESULTS Compared to PD patients with mild-moderate NMSB, the severe-very severe NMSB group showed slower gait speed and shorter stride length under both ST and DT conditions (p < 0.05). DT had significantly negative effect on gait parameters in PD patients, including gait speed, stride length, and gait cycle duration (p < 0.05). PD patients with mild-moderate NMSB showed larger DTEs of cadence and bilateral gait cycle duration (p < 0.05). DTEs of bilateral gait cycle duration and swing phase on the more affected (MA) side were significantly correlated with NMSS scores (∣rSp∣ ≥ 0.3, p < 0.05). Gait cycle duration on the less affected (LA) side explained 43% of the variance in NMSS scores, when accounting for demographic and clinical confounders (β = - 1.095 95% CI - 4.061 ~ - 0.058, p = 0.044; adjusted R2 = 0.434). CONCLUSION DT gait performance could reflect NMSB in PD patients at early stage, and gait cycle duration is a valuable gait parameter to further investigate and to provide more evidence for PD management.
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Affiliation(s)
- Meimei Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yawen Gan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xuemei Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhan Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tao Feng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- China National Clinical Research Center for Neurological Diseases (NCRC-ND), Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
| | - Yumei Zhang
- China National Clinical Research Center for Neurological Diseases (NCRC-ND), Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
- China National Clinical Research Center for Neurological Diseases, Department of Rehabilitation, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
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Huang CY, Chen YA, Wu RM, Hwang IS. Dual-task walking improvement with enhanced kinesthetic awareness in Parkinson’s disease with mild gait impairment: EEG connectivity and clinical implication. Front Aging Neurosci 2022; 14:1041378. [DOI: 10.3389/fnagi.2022.1041378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 11/10/2022] [Indexed: 12/02/2022] Open
Abstract
Due to basal ganglia dysfunction, short step length is a common gait impairment in Parkinson’s disease (PD), especially in a dual-task walking. Here, we use electroencephalography (EEG) functional connectivity to investigate neural mechanisms of a stride awareness strategy that could improve dual-task walking in PD. Eighteen individuals with PD who had mild gait impairment walked at self-paced speed while keeping two interlocking rings from touching each other. During the dual-task walking trial, the participants received or did not receive awareness instruction to take big steps. Gait parameters, ring-touching time, and EEG connectivity in the alpha and beta bands were analyzed. With stride awareness, individuals with PD exhibited greater gait velocity and step length, along with a significantly lower mean EEG connectivity strength in the beta band. The awareness-related changes in the EEG connectivity strength of the beta band positively correlated with the awareness-related changes in gait velocity, cadence, and step length, but negatively correlated with the awareness-related change in step-length variability. The smaller reduction in beta connectivity strength was associated with greater improvement in locomotion control with stride awareness. This study is the first to reveal that a stride awareness strategy modulates the beta band oscillatory network and is related to walking efficacy in individuals with PD in a dual-task condition.
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Bezerra PT, Santiago LM, Silva IA, Souza AA, Pegado CL, Damascena CM, Ribeiro TS, Lindquist AR. Action observation and motor imagery have no effect on balance and freezing of gait in Parkinson's disease: a randomized controlled trial. Eur J Phys Rehabil Med 2022; 58:715-722. [PMID: 36052889 PMCID: PMC10019482 DOI: 10.23736/s1973-9087.22.07313-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 06/14/2022] [Accepted: 08/25/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Combining action observation (AO) and motor imagery (MI) training may induce greater brain activity in areas usually involved in Parkinson's disease (PD) and lead to greater behavioral and neurophysiological effects than when used separately. AIM To determine the effects of combining AO, MI, and gait training on balance and freezing of gait in individuals with PD. DESIGN This is a single-blinded, randomized controlled clinical trial. SETTING Laboratory of Intervention and Analysis of Movement (LIAM) from the Department of Physical Therapy of a Brazilian University. POPULATION Study sample consisted of individuals diagnosed with idiopathic PD by a neurologist specialized in movement disorders. METHODS 39 individuals with PD were divided into experimental (EG=21) and control groups (CG=18). EG performed 12 sessions of AO, MI, and gait training, whereas CG watched PD-related educational videos and performed 12 sessions of gait training. Balance (measured using the Mini Balance Evaluation Systems Test [MiniBESTest]) and freezing of gait (measured using the Freezing of Gait Questionnaire) were reassessed one day after the end of the intervention. RESULTS We did not observe significant intra- and intergroup differences in freezing of gait. For the EG, we observed a significant intragroup difference in the total score of MiniBESTest (F=5.2; P=0.02), and sensory orientation (F=4.5; P=0.04) and dynamic gait (F=3.6; P=0.03) domains. MiniBESTest domains were not different between groups. CONCLUSIONS Combining AO, MI, and gait training was not more effective than isolated gait training for balance and freezing of gait in individuals with PD. CLINICAL REHABILITATION IMPACT MI training can moderate AO effects and enhance motor learning when both therapies are combined. Therefore, this approach may still have the potential to be included in the treatment of PD. New studies should investigate whether the factors that influence these results are related to the protocol's sensitivity in changing the evaluated parameters or to the time and intensity of AO and MI training.
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Affiliation(s)
- Paula T Bezerra
- Department of Physical Therapy, Rio Grande do Norte Federal University, Natal, Rio Grande do Norte, Brazil
| | - Lorenna M Santiago
- Department of Physical Therapy, Rio Grande do Norte Federal University, Natal, Rio Grande do Norte, Brazil
- Anita Garibaldi Education and Health Research Center, Santos Dumont Institute, Macaíba, Rio Grande do Norte, Brazil
| | - Isaíra A Silva
- Department of Physical Therapy, Rio Grande do Norte Federal University, Natal, Rio Grande do Norte, Brazil
| | - Aline A Souza
- Department of Physical Therapy, Rio Grande do Norte Federal University, Natal, Rio Grande do Norte, Brazil
| | - Camila L Pegado
- Department of Physical Therapy, Rio Grande do Norte Federal University, Natal, Rio Grande do Norte, Brazil
| | - Clécia M Damascena
- University of Estácio do Rio Grande do Norte (Fatern), Natal, Rio Grande do Norte, Brazil
| | - Tatiana S Ribeiro
- Department of Physical Therapy, Rio Grande do Norte Federal University, Natal, Rio Grande do Norte, Brazil
| | - Ana R Lindquist
- Department of Physical Therapy, Rio Grande do Norte Federal University, Natal, Rio Grande do Norte, Brazil -
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Quek DYL, Economou K, MacDougall H, Lewis SJG, Ehgoetz Martens KA. The influence of visual feedback on alleviating freezing of gait in Parkinson's disease is reduced by anxiety. Gait Posture 2022; 95:70-75. [PMID: 35453086 DOI: 10.1016/j.gaitpost.2022.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/07/2022] [Accepted: 04/10/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Previous research has established that anxiety is associated with freezing of gait (FOG) in Parkinson's disease (PD). Although providing body-related visual feedback has been previously suggested to improve FOG, it remains unclear whether anxiety-induced FOG might be improved. RESEARCH QUESTION The current study aimed to evaluate whether body-related visual feedback (VF) improves FOG consistently across low and high threat conditions. METHODS Sixteen PD patients with FOG were instructed to walk across a plank in a virtual environment that was either located on the ground (low threat) or elevated above a deep pit (high threat). Additionally, visual feedback (VF) was either provided (+) or omitted (-) using an avatar that was synchronised in real-time with the participants movements. RESULTS revealed that in the low threat condition (i.e., ground), %FOG was significantly reduced when VF was provided (VF+) compared to when VF was absent (VF-). In contrast, during the elevated high threat condition, there were no differences in %FOG regardless of whether VF was provided or not. SIGNIFICANCE These findings confirm that although VF can aid in the reduction of FOG, anxiety may interfere with freezers' ability to use sensory feedback to improve FOG and hence, in high threat conditions, VF was unable to aid in the reduction of FOG. Future studies should direct efforts towards the treatment of anxiety to determine whether better management of anxiety may improve FOG.
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Affiliation(s)
- Dione Y L Quek
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Australia.
| | - Kristin Economou
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Australia.
| | | | - Simon J G Lewis
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Australia.
| | - Kaylena A Ehgoetz Martens
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Australia; Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada.
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Pelosin E, Ponte C, Putzolu M, Lagravinese G, Hausdorff JM, Nieuwboer A, Ginis P, Rochester L, Alcock L, Bloem BR, Nieuwhof F, Cereatti A, Della Croce U, Mirelman A, Avanzino L. Motor–Cognitive Treadmill Training With Virtual Reality in Parkinson’s Disease: The Effect of Training Duration. Front Aging Neurosci 2022; 13:753381. [PMID: 35069171 PMCID: PMC8767105 DOI: 10.3389/fnagi.2021.753381] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/17/2021] [Indexed: 01/11/2023] Open
Abstract
Treadmill training with virtual reality (TT + VR) has been shown to improve gait performance and to reduce fall risk in Parkinson’s disease (PD). However, there is no consensus on the optimal training duration. This study is a sub-study of the V-TIME randomized clinical trial (NCT01732653). In this study, we explored the effect of the duration of training based on the motor–cognitive interaction on motor and cognitive performance and on fall risk in subjects with PD. Patients in Hoehn and Yahr stages II–III, aged between 40 and 70 years, were included. In total, 96 patients with PD were assigned to 6 or 12 weeks of TT + VR intervention, and 77 patients completed the full protocol. Outcome measures for gait and cognitive performance were assessed at baseline, immediately after training, and at 1- and 6-month follow-up. The incident rate of falls in the 6-month pre-intervention was compared with that in the 6-month post-intervention. Dual-task gait performance (gait speed, gait speed variability and stride length under cognitive dual task and obstacle negotiation, and the leading foot clearance in obstacle negotiation) improved similarly in both groups with gains sustained at 6-month follow-up. A higher decrease in fall rate and fear of falling were observed in participants assigned to the 12-week intervention than the 6-week intervention. Improvements in cognitive functions (i.e., executive functions, visuospatial ability, and attention) were seen only in participants enrolled in 12-week training up to 1-month follow-up but vanished at the 6-month evaluation. Our results suggest that a longer TT + VR training leads to greater improvements in cognitive functions especially those directly addressed by the virtual environment.
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Affiliation(s)
- Elisa Pelosin
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- *Correspondence: Elisa Pelosin,
| | - Chiara Ponte
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Genova, Italy
| | - Martina Putzolu
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Genova, Italy
| | - Giovanna Lagravinese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Jeffrey M. Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Department of Physical Therapy, Tel Aviv University, Tel Aviv, Israel
- Department of Orthopedic Surgery, Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States
| | - Alice Nieuwboer
- Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), KU Leuven, Leuven, Belgium
| | - Pieter Ginis
- Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), KU Leuven, Leuven, Belgium
| | - Lynn Rochester
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Lisa Alcock
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Bastiaan R. Bloem
- Department of Neurology, Radboud University Medical Centre, Centre of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | - Freek Nieuwhof
- Department of Neurology, Radboud University Medical Centre, Centre of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | - Andrea Cereatti
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
- Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | - Ugo Della Croce
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Anat Mirelman
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Laura Avanzino
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Experimental Medicine, Section of Human Physiology, University of Genoa, Genoa, Italy
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Tosserams A, Wit L, Sturkenboom IHWM, Nijkrake MJ, Bloem BR, Nonnekes J. Perception and Use of Compensation Strategies for Gait Impairment by Persons With Parkinson Disease. Neurology 2021; 97:e1404-e1412. [PMID: 34497067 PMCID: PMC8520387 DOI: 10.1212/wnl.0000000000012633] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 07/07/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Gait impairments are common and disabling in Parkinson disease (PD). Applying compensation strategies helps to overcome these gait deficits. Clinical observations suggest that the efficacy of different compensation strategies varies depending on both individual patient characteristics and the context in which the strategies are applied. This has never been investigated systematically, hampering the ability of clinicians to provide a more personalized approach to gait rehabilitation. We had 3 aims: (1) to evaluate patients' awareness and actual use of compensation categories for gait impairments in PD, (2) to investigate the patient-rated efficacy of the various compensation strategies and whether this efficacy depends on the context in which the strategies are applied, and (3) to explore differences in the efficacy between subgroups based on sex, age, disease duration, freezing status, and ability to perform a dual task. METHODS A survey was conducted among 4,324 adults with PD and self-reported disabling gait impairments. RESULTS The main findings are as follows: (1) compensation strategies for gait impairments are commonly used by persons with PD, but their awareness of the full spectrum of available strategies is limited; (2) the patient-rated efficacy of compensation strategies is high but varies depending on the context in which they are applied; and (3) compensation strategies are useful for all types of patients with PD, but the efficacy of the different strategies varies per person. DISCUSSION The choice of compensation strategies for gait impairment in PD should be tailored to the individual patient and to the context in which the strategy needs to be applied. CLASSIFICATION OF EVIDENCE This data provides Class IV evidence that compensation strategies are an effective treatment for gait impairment in patients with PD.
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Affiliation(s)
- Anouk Tosserams
- From the Department of Neurology (A.T., B.R.B.) and Department of Rehabilitation (A.T., L.W., I.H.W.M.S., M.J.N., J.N.), Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre; and Department of Rehabilitation (J.N.), Sint Maartenskliniek, Nijmegen, the Netherlands.
| | - Lisanne Wit
- From the Department of Neurology (A.T., B.R.B.) and Department of Rehabilitation (A.T., L.W., I.H.W.M.S., M.J.N., J.N.), Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre; and Department of Rehabilitation (J.N.), Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Ingrid H W M Sturkenboom
- From the Department of Neurology (A.T., B.R.B.) and Department of Rehabilitation (A.T., L.W., I.H.W.M.S., M.J.N., J.N.), Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre; and Department of Rehabilitation (J.N.), Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Maarten J Nijkrake
- From the Department of Neurology (A.T., B.R.B.) and Department of Rehabilitation (A.T., L.W., I.H.W.M.S., M.J.N., J.N.), Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre; and Department of Rehabilitation (J.N.), Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Bastiaan R Bloem
- From the Department of Neurology (A.T., B.R.B.) and Department of Rehabilitation (A.T., L.W., I.H.W.M.S., M.J.N., J.N.), Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre; and Department of Rehabilitation (J.N.), Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Jorik Nonnekes
- From the Department of Neurology (A.T., B.R.B.) and Department of Rehabilitation (A.T., L.W., I.H.W.M.S., M.J.N., J.N.), Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre; and Department of Rehabilitation (J.N.), Sint Maartenskliniek, Nijmegen, the Netherlands
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Canesi M, Ghilardi MF. Editorial: Integrated Motor-Cognitive Aerobic Rehabilitation Approaches in Parkinson's Disease. Front Neurol 2021; 12:677721. [PMID: 34421785 PMCID: PMC8371048 DOI: 10.3389/fneur.2021.677721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/03/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Margherita Canesi
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, Moriggia Pelascini Hospital, Gravedona, Italy
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11
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D'Cruz N, Seuthe J, Ginis P, Hulzinga F, Schlenstedt C, Nieuwboer A. Short-Term Effects of Single-Session Split-Belt Treadmill Training on Dual-Task Performance in Parkinson's Disease and Healthy Elderly. Front Neurol 2020; 11:560084. [PMID: 33101174 PMCID: PMC7554617 DOI: 10.3389/fneur.2020.560084] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/19/2020] [Indexed: 12/30/2022] Open
Abstract
Background: Dual-tasking is challenging for people with Parkinson's disease and freezing of gait (PD+FOG) and can exacerbate freezing episodes and falls. Split-belt treadmill training (SBT) is a novel tool to train complex gait and may improve dual-task (DT) walking and turning. Objective: To investigate the single-session effects of SBT on DT walking and DT turning performance in PD+FOG and older adults (OA), compared to regular treadmill training. Methods: Forty-five PD+FOG and 36 OA participated in a single training session (30 min). They were randomized into one of four training groups: (A) SB75—steady belt speed ratio 0.75:1; (B) SB50—steady belt speed ratio 0.5:1; (C) SBCR—changing belt speed ratios between 0.75:1 and 0.5:1; and (D) Tied-Belt (TBT). Over-ground straight-line gait and an alternating turning in place task combined with a cognitive dual-task (DT) (auditory Stroop) were assessed pre- and post-training, and the following day (retention). Constrained longitudinal data analysis was used to investigate the training effects for all participants and for PD+FOG alone. Results: DT gait speed improved at post-training for all groups (p < 0.001). However, SBT (SB50 and SBCR) led to larger post-training improvements compared to TBT, which were still visible at retention (SB50). For mean DT turning speed and Stroop response time while walking, only SBT groups showed significant improvements at post-training or retention. DT stride length, peak DT turning speed, and Stroop performance index while walking also showed larger gains in SBT compared to TBT. Results for PD+FOG alone showed similar effects although with smaller effect sizes. Conclusions: A single session of SBT in PD+FOG and OA showed larger short-term effects on DT walking and turning compared to TBT. Cognitive DT performance was also improved in SBT, likely due to reduced cortical control of gait. These results illustrate the potential for SBT to improve DT during complex gait and possibly reduce fall risk in clinical and healthy populations.
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Affiliation(s)
- Nicholas D'Cruz
- Neurorehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Jana Seuthe
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University (CAU) Kiel, Kiel, Germany
| | - Pieter Ginis
- Neurorehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Femke Hulzinga
- Neurorehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Christian Schlenstedt
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University (CAU) Kiel, Kiel, Germany
| | - Alice Nieuwboer
- Neurorehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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12
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Rahman MM, Chakraborti RR, Potol MA, Abir AH, Sharmin O, Alam M, Khan MFR, Afrin R, Jannat H, Wadud R, Habib ZF. Epalrestat improves motor symptoms by reducing oxidative stress and inflammation in the reserpine induced mouse model of Parkinson's disease. Animal Model Exp Med 2020; 3:9-21. [PMID: 32318655 PMCID: PMC7167235 DOI: 10.1002/ame2.12097] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 11/12/2019] [Accepted: 12/06/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) is a progressive neurodegenerative disorder affecting a large number of elderly people worldwide. The current therapies for PD are symptom-based; they do not provide a cure but improve the quality of life. Muscular dysfunction is the hallmark clinical feature of PD and oxidative stress and inflammation play a critical role in its pathogenesis. Epalrestat is used for the treatment of diabetic neuropathy and is known to improve antioxidative defense mechanisms in the CNS. Therefore, in this study, we investigated the role of Epalrestat in the reserpine induced mouse model of PD. METHOD We used Swiss Albino mice for the PD model and tested for akinesia/bradykinesia, muscular rigidity, palpebral ptosis, and tremor, as well as conducting swim and open field tests. Brain samples were used to determine oxidative stress parameters and infiltration of immune cells. RESULTS Epalrestat treatment significantly improved akinesia and bradykinesia, muscular dysfunctions, tremor level, and gait functions compared to the reserpine group. It also improved the latency in the swim test. Eplarestat significantly reduced lipid peroxidation and NO concentration in different brain tissues and increased the activity of antioxidative enzymes, glutathione, catalase, and superoxide dismutase. Furthermore, Epalrestat reduced neuroinflammation by reducing the number of infiltrating immune cells. CONCLUSION Eplarestat improves muscular dysfunction in PD by reducing oxidative stress and inflammation.
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Affiliation(s)
- Md. Mahbubur Rahman
- Laboratory of PharmacologyDepartment of Pharmaceutical SciencesSchool of Health & Life SciencesNorth South UniversityDhakaBangladesh
| | - Rupali Rani Chakraborti
- Laboratory of PharmacologyDepartment of Pharmaceutical SciencesSchool of Health & Life SciencesNorth South UniversityDhakaBangladesh
| | - Md. Abdullah Potol
- Laboratory of PharmacologyDepartment of Pharmaceutical SciencesSchool of Health & Life SciencesNorth South UniversityDhakaBangladesh
| | - Ariful Haque Abir
- Laboratory of PharmacologyDepartment of Pharmaceutical SciencesSchool of Health & Life SciencesNorth South UniversityDhakaBangladesh
| | - Ozayra Sharmin
- Laboratory of PharmacologyDepartment of Pharmaceutical SciencesSchool of Health & Life SciencesNorth South UniversityDhakaBangladesh
| | - Mahabub Alam
- Laboratory of PharmacologyDepartment of Pharmaceutical SciencesSchool of Health & Life SciencesNorth South UniversityDhakaBangladesh
| | - Md. Fazlur Rahman Khan
- Laboratory of PharmacologyDepartment of Pharmaceutical SciencesSchool of Health & Life SciencesNorth South UniversityDhakaBangladesh
| | - Rownock Afrin
- Laboratory of PharmacologyDepartment of Pharmaceutical SciencesSchool of Health & Life SciencesNorth South UniversityDhakaBangladesh
| | - Humayra Jannat
- Laboratory of PharmacologyDepartment of Pharmaceutical SciencesSchool of Health & Life SciencesNorth South UniversityDhakaBangladesh
| | - Rasiqh Wadud
- Laboratory of PharmacologyDepartment of Pharmaceutical SciencesSchool of Health & Life SciencesNorth South UniversityDhakaBangladesh
| | - Zaki Farhad Habib
- Laboratory of PharmacologyDepartment of Pharmaceutical SciencesSchool of Health & Life SciencesNorth South UniversityDhakaBangladesh
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13
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Abstract
Parkinson's disease (PD) is an aging-related neurodegenerative disorder characterized by progressive motor impairment.The etiology of PD is poorly understood but likely involves both genetic and environmental factors; the management of the disease is still with symptomatic therapy without any interference on the progression of neurodegeneration. In the past two decades, the results of a series of prospective cohort studies suggested that lifestyle factors likely modify the risk of developing PD. Among these, physical activity is known to reduce the risk of a wide range of diseases and conditions, including cardiovascular disease, stroke, and diabetes.Recently, a growing body of evidence has suggested that increased physical activity may also reduce the risk of PD and partly improve motor and non-motor symptoms during the disease course.Here we report the main findings on the effect of physical activity on both mobility and cognition either in animal models of PD or in people with PD. We also highlighted the structural and functional links between gait and cognition by reporting evidence from neuroimaging studies.
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Affiliation(s)
- Simona Bonavita
- II Clinic of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.
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14
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Pazzaglia C, Imbimbo I, Tranchita E, Minganti C, Ricciardi D, Lo Monaco R, Parisi A, Padua L. Comparison of virtual reality rehabilitation and conventional rehabilitation in Parkinson's disease: a randomised controlled trial. Physiotherapy 2019; 106:36-42. [PMID: 32026844 DOI: 10.1016/j.physio.2019.12.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 08/11/2019] [Accepted: 12/18/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To compare a 6-week virtual reality (VR) rehabilitation programme with a conventional rehabilitation programme in patients with Parkinson's disease. DESIGN Prospective, single-blinded, randomised controlled trial. SETTING Outpatients. PARTICIPANTS Fifty-one patients with Parkinson's disease were assigned at random to a VR rehabilitation programme or a conventional rehabilitation programme. INTERVENTIONS Both programmes ran for 6 consecutive weeks, with a 40-minute session three times per week. MAIN OUTCOME MEASURES The Balance Berg Scale (BBS) was used to measure balance. Secondary outcome measures were: Dynamic Gait Index (DGI) to evaluate ability to adapt gait to complex walking tasks; Disabilities of the Arm, Shoulder and Hand (DASH) scale to measure performance of the upper limb; and Short Form 36 (SF-36) to evaluate quality of life. RESULTS The VR rehabilitation programme led to an increase in BBS score {45.6 [standard deviation (SD) 7.9] vs 49.2 (SD 8.1), mean difference 3.6, 95% confidence interval (CI) 1.3 to 5.9; P=0.003}, DGI score [18.7 (SD 4.7) vs 20.2 (SD 4.2), mean difference 1.6, 95% CI 0.6 to 2.5; P=0.003] and SF-36 mental composite score [37.7 (SD 11.4) vs 43.5 (SD 9.2), mean difference 5.8, 95% CI 0.4 to 11.3; P=0.037], and a decrease in DASH scale score [29.6 (SD 17.5) vs 21.6 (SD 15.1), mean difference -7.9, 95% CI -13.7 to -2.2; P=0.009]. In contrast, the conventional rehabilitation programme only led to a decrease in DASH scale score [30.3 (SD 18.1) vs 25.1 (SD 15.8), mean difference -5.2, 95% CI -8.8 to -1.5; P=0.007]. CONCLUSION These findings suggest that rehabilitation is useful in Parkinson's disease, and the VR rehabilitation programme was more effective in determining overall improvement than the conventional rehabilitation programme. CLINICAL TRIAL REGISTRATION NUMBER NCT02807740.
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Affiliation(s)
- C Pazzaglia
- Department of Neurorehabilitation, IRCCS Don Carlo Gnocchi, Milan, Italy
| | - I Imbimbo
- Department of Neurorehabilitation, IRCCS Don Carlo Gnocchi, Milan, Italy
| | - E Tranchita
- Department of Movement, Human and Health Sciences, Division of Health Sciences, University of Rome Foro Italico, Rome, Italy
| | - C Minganti
- Department of Movement, Human and Health Sciences, Division of Health Sciences, University of Rome Foro Italico, Rome, Italy
| | - D Ricciardi
- Department of Geriatrics, Neurosciences and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - R Lo Monaco
- Department of Geriatrics, Neurosciences and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Parisi
- Department of Movement, Human and Health Sciences, Division of Health Sciences, University of Rome Foro Italico, Rome, Italy
| | - L Padua
- Department of Geriatrics, Neurosciences and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy; UO Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
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15
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Effects of motor imagery training of Parkinson's disease: a protocol for a randomized clinical trial. Trials 2019; 20:626. [PMID: 31706325 PMCID: PMC6842520 DOI: 10.1186/s13063-019-3694-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 08/31/2019] [Indexed: 11/10/2022] Open
Abstract
Background Gait disorders in individuals with Parkinson’s disease (PD) may be associated with alterations in the motor control system and aggravated by psychoemotional and cognitive issues. Therapeutic strategies aimed at self-perception and motor regulation seem to be promising. Motor imagery (MI) has been shown to be one of these strategies, but there is still no clear evidence of its applicability in this population. The aim of this trial is to determine the effects of motor-imagery training on the gait and electroencephalographic activity of individuals with PD. Methods/design The sample will consist of 40 individuals, aged between 45 and 75 years, in the mild and moderate phase of the disease, with the ability to generate voluntary mental images. They will be assessed for cognitive level, degree of physical disability, mental-image clarity, kinematic gait variables, electroencephalographic activity and mobility. Next, subjects will be randomly assigned to an experimental group (EG) and a control group (CG). The EG will perform motor imagery and gait, while the CG will only engage in gait exercises. Twelve training sessions will be conducted lasting up to 90 min each, three times a week, for 4 weeks. The subjects will be reassessed on the kinematic variables of gait, electroencephalographic activity and mobility at 1, 7 and 30 days after the final training session. Discussion The results may provide an important advance in neurological rehabilitation where an easy-access and low-cost intervention may help to improve gait, electroencephalographic activity and mobility in individuals with PD. Trial registration Clinicaltrials.gov, ID: NCT03439800. Registered on 15 November 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3694-8) contains supplementary material, which is available to authorized users.
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16
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Fundarò C, Maestri R, Ferriero G, Chimento P, Taveggia G, Casale R. Self-selected speed gait training in Parkinson's disease: robot-assisted gait training with virtual reality versus gait training on the ground. Eur J Phys Rehabil Med 2019; 55:456-462. [DOI: 10.23736/s1973-9087.18.05368-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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17
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Intzandt B, Beck EN, Silveira CR. The effects of exercise on cognition and gait in Parkinson’s disease: A scoping review. Neurosci Biobehav Rev 2018; 95:136-169. [DOI: 10.1016/j.neubiorev.2018.09.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 09/23/2018] [Accepted: 09/24/2018] [Indexed: 10/28/2022]
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18
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Parry R, Buttelli O, Riff J, Sellam N, Vidailhet M, Welter ML, Lalo E. "The whole perimeter is difficult": Parkinson's disease and the conscious experience of walking in everyday environments. Disabil Rehabil 2018; 41:2784-2791. [PMID: 29916272 DOI: 10.1080/09638288.2018.1479779] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose: This study sought to characterize the way patients with Parkinson's disease consciously perceive and respond to their surroundings while walking in everyday situations.Method: A qualitative research program designed around an ecological data collection protocol was employed. A convenience sample of 14 patients with a diagnosis of Parkinson's disease and a history of gait difficulties were recruited. Details regarding patients' subjective experience of walking in everyday environments were obtained using first person interviewing techniques with the support of video footage from their daily-life activity. Interview transcripts were analyzed using an interpretive phenomenological approach in order to derive key themes.Results: The sense of proximity and the way in which an individual perceived themselves with respect to their surroundings appeared central to the way patients organized their locomotor behavior. Further to this, the patient relationship to different features and obstacles appeared conditioned by prior experiences in those circumstances. Patients described managing gait difficulties by consciously regulating their walking trajectory and gaze with respect to their environment.Conclusion: Perceptual challenges, visual flow and the dynamic valence of features in the patient's surroundings may have important effects upon the gait stability of patients with Parkinson's disease and warrant further attention in planning rehabilitation interventions.Implications for rehabilitationWalking abilities of patients with Parkinson's disease should be conceptualized in terms of perceptuomotor coupling to a given environment.The functional significance of a patient's environment is dynamic and might be seen to vary in accordance with their physical capacities.Valency, or the subjective relationship between a patient and their surrounds, appears to be an important component of the "fit" between a person and their environment.Novel rehabilitation strategies for the management of parkinsonian gait disturbances might seek to integrate psychological, sensorimotor and environmental elements in order to have individually tailored, ecologically valid home assessment and community rehabilitation programs.
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Affiliation(s)
- Ross Parry
- Institut du Cerveau et de la Moelle épinière, Paris, France.,Institut des Systèmes Intelligents et de Robotique, Paris, France
| | | | - Jacques Riff
- Pôle STAPS, Université d'Orléans, Orléans, France
| | - Narjis Sellam
- Institut du Cerveau et de la Moelle épinière, Paris, France
| | - Marie Vidailhet
- Institut du Cerveau et de la Moelle épinière, Paris, France.,Département de Neurologie, Groupe Hospitalier Pitie´-Salpêtrière, Paris, France
| | - Marie-Laure Welter
- Institut du Cerveau et de la Moelle épinière, Paris, France.,Plateforme d'Analyse du Mouvement (PANAM-CENIR), Institut du Cerveau et de la Moelle Epinière, Paris, France.,Service de Neurophysiologie, Hôpital Charles Nicolle, Rouen, France
| | - Elodie Lalo
- Institut du Cerveau et de la Moelle épinière, Paris, France.,Pôle STAPS, Université d'Orléans, Orléans, France
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19
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Barbosa AF, Chen J, Freitag F, Valente D, Souza CDO, Voos MC, Chien HF. Gait, posture and cognition in Parkinson's disease. Dement Neuropsychol 2016; 10:280-286. [PMID: 29213470 PMCID: PMC5619266 DOI: 10.1590/s1980-5764-2016dn1004005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Gait disorders and postural instability are the leading causes of falls and
disability in Parkinson's disease (PD). Cognition plays an important role in
postural control and may interfere with gait and posture assessment and
treatment. It is important to recognize gait, posture and balance dysfunctions
by choosing proper assessment tools for PD. Patients at higher risk of falling
must be referred for rehabilitation as early as possible, because
antiparkinsonian drugs and surgery do not improve gait and posture in PD.
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Affiliation(s)
- Alessandra Ferreira Barbosa
- Physical Therapy, Occupational Therapy and Speech Therapy Department, University of São Paulo School of Medicine, São Paulo, SP, Brazil.,ReMove. Rehabilitation of Movement Disorders Research Group
| | - Janini Chen
- Movement Disorders Clinic of Hospital das Clinicas of the Department of Neurology. University of São Paulo School of Medicine, São Paulo, SP, Brazil.,ReMove. Rehabilitation of Movement Disorders Research Group
| | - Fernanda Freitag
- Movement Disorders Clinic of Hospital das Clinicas of the Department of Neurology. University of São Paulo School of Medicine, São Paulo, SP, Brazil
| | - Debora Valente
- Movement Disorders Clinic of Hospital das Clinicas of the Department of Neurology. University of São Paulo School of Medicine, São Paulo, SP, Brazil.,ReMove. Rehabilitation of Movement Disorders Research Group
| | - Carolina de Oliveira Souza
- Movement Disorders Clinic of Hospital das Clinicas of the Department of Neurology. University of São Paulo School of Medicine, São Paulo, SP, Brazil.,ReMove. Rehabilitation of Movement Disorders Research Group
| | - Mariana Callil Voos
- Physical Therapy, Occupational Therapy and Speech Therapy Department, University of São Paulo School of Medicine, São Paulo, SP, Brazil.,ReMove. Rehabilitation of Movement Disorders Research Group
| | - Hsin Fen Chien
- Movement Disorders Clinic of Hospital das Clinicas of the Department of Neurology. University of São Paulo School of Medicine, São Paulo, SP, Brazil.,ReMove. Rehabilitation of Movement Disorders Research Group.,Institute of Orthopedics and Traumatology of Hospital das Clínicas of University of São Paulo School of Medicine, São Paulo, SP, Brazil
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20
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Santiago LMDM, de Oliveira DA, de Macêdo Ferreira LGL, de Brito Pinto HY, Spaniol AP, de Lucena Trigueiro LC, Ribeiro TS, de Sousa AVC, Piemonte MEP, Lindquist ARR. Immediate effects of adding mental practice to physical practice on the gait of individuals with Parkinson's disease: Randomized clinical trial. NeuroRehabilitation 2016; 37:263-71. [PMID: 26484518 DOI: 10.3233/nre-151259] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Mental practice has shown benefits in the rehabilitation of neurological patients, however, there is no evidence of immediate effects on gait of individuals with Parkinson's disease. OBJECTIVE Determine the effects of mental practice activity added to physical practice on the gait of individuals with Idiopathic Parkinson's Disease (IPD). METHODS 20 patients classified with stage 2 and 3, according to the Hoehn and Yahr scale were randomized into 2 groups. The experimental group (N = 10) was submitted to a single session of mental practice and physical practice gait protocol and the control group (N = 10) only to physical practice. The primary outcomes were stride length and total stance and swing time. Secondary outcomes were hip range of motion, velocity and mobility. Subjects were reassessed 10 minutes, 1 day and 7 days after the end of the session. RESULTS There was no statistically significant difference between the groups. An intragroup difference was observed in velocity, stride length, hip range of motion, and mobility, as well as total stance and swing time. These results were also observed on follow-ups. CONCLUSIONS Mental practice did not have a greater effect on the gait of individuals with IPD than physical practice, after a single session.
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Affiliation(s)
| | | | | | | | - Ana Paula Spaniol
- Department of Physiotherapy, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | - Tatiana Souza Ribeiro
- Department of Physiotherapy, Federal University of Rio Grande do Norte, Natal, Brazil
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21
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Nackaerts E, Heremans E, Vervoort G, Smits-Engelsman BCM, Swinnen SP, Vandenberghe W, Bergmans B, Nieuwboer A. Relearning of Writing Skills in Parkinson's Disease After Intensive Amplitude Training. Mov Disord 2016; 31:1209-16. [PMID: 26990651 DOI: 10.1002/mds.26565] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/08/2016] [Accepted: 01/12/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Micrographia occurs in approximately 60% of people with Parkinson's disease (PD). Although handwriting is an important task in daily life, it is not clear whether relearning and consolidation (ie the solid storage in motor memory) of this skill is possible in PD. The objective was to conduct for the first time a controlled study into the effects of intensive motor learning to improve micrographia in PD. METHODS In this placebo-controlled study, 38 right-handed people with PD were randomized into 2 groups, receiving 1 of 2 equally time-intensive training programs (30 min/day, 5 days/week for 6 weeks). The experimental group (n = 18) performed amplitude training focused at improving writing size. The placebo group (n = 20) received stretch and relaxation exercises. Participants' writing skills were assessed using a touch-sensitive writing tablet and a pen-and-paper test, pre- and posttraining, and after a 6-week retention period. The primary outcome was change in amplitude during several tests of consolidation: (1) transfer, using trained and untrained sequences performed with and without target zones; and (2) automatization, using single- and dual-task sequences. RESULTS The group receiving amplitude training significantly improved in amplitude and variability of amplitude on the transfer and automatization task. Effect sizes varied between 7% and 17%, and these benefits were maintained after the 6-week retention period. Moreover, there was transfer to daily life writing. CONCLUSIONS These results show automatization, transfer, and retention of increased writing size (diminished micrographia) after intensive amplitude training, indicating that consolidation of motor learning is possible in PD. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Evelien Nackaerts
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Heverlee, Belgium
| | - Elke Heremans
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Heverlee, Belgium
| | - Griet Vervoort
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Heverlee, Belgium
| | - Bouwien C M Smits-Engelsman
- Movement Control and Neuroplasticity Research Group, Department of Kinesiology, KU Leuven, Heverlee, Belgium
| | - Stephan P Swinnen
- Movement Control and Neuroplasticity Research Group, Department of Kinesiology, KU Leuven, Heverlee, Belgium
| | - Wim Vandenberghe
- Laboratory for Parkinson Research, Department of Neurosciences, KU Leuven, Heverlee, Belgium.,Department of Neurology, University Hospitals Leuven, Heverlee, Belgium
| | - Bruno Bergmans
- Department of Neurology, A.Z. Sint-Jan Brugge-Oostende AV, Bruges, Belgium
| | - Alice Nieuwboer
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Heverlee, Belgium
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22
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Brain activity during walking: A systematic review. Neurosci Biobehav Rev 2015; 57:310-27. [PMID: 26306029 DOI: 10.1016/j.neubiorev.2015.08.002] [Citation(s) in RCA: 194] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 05/27/2015] [Accepted: 08/02/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND This systematic review provides an overview of the literature deducing information about brain activation during (1) imagined walking using MRI/fMRI or (2) during real walking using measurement systems as fNIRS, EEG and PET. METHODS Three independent reviewers undertook an electronic database research browsing six databases. The search request consisted of three search fields. The first field comprised common methods to evaluate brain activity. The second search field comprised synonyms for brain responses to movements. The third search field comprised synonyms for walking. RESULTS 48 of an initial yield of 1832 papers were reviewed. We found differences in cortical activity regarding young vs. old individuals, physically fit vs. physically unfit cohorts, healthy people vs. patients with neurological diseases, and between simple and complex walking tasks. CONCLUSIONS We summarize that the dimension of brain activity in different brain areas during walking is highly sensitive to task complexity, age and pathologies supporting previous assumptions underpinning the significance of cortical control. Many compensation mechanisms reflect the brain's plasticity which ensures stable walking.
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23
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Nackaerts E, Nieuwboer A, Broeder S, Smits-Engelsman BCM, Swinnen SP, Vandenberghe W, Heremans E. Opposite Effects of Visual Cueing During Writing-Like Movements of Different Amplitudes in Parkinson's Disease. Neurorehabil Neural Repair 2015; 30:431-9. [PMID: 26276122 DOI: 10.1177/1545968315601361] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Handwriting is often impaired in Parkinson's disease (PD). Several studies have shown that writing in PD benefits from the use of cues. However, this was typically studied with writing and drawing sizes that are usually not used in daily life. OBJECTIVE This study examines the effect of visual cueing on a prewriting task at small amplitudes (≤1.0 cm) in PD patients and healthy controls to better understand the working action of cueing for writing. METHODS A total of 15 PD patients and 15 healthy, age-matched controls performed a prewriting task at 0.6 cm and 1.0 cm in the presence and absence of visual cues (target lines). Writing amplitude, variability of amplitude, and speed were chosen as dependent variables, measured using a newly developed touch-sensitive tablet. RESULTS Cueing led to immediate improvements in writing size, variability of writing size, and speed in both groups in the 1.0 cm condition. However, when writing at 0.6 cm with cues, a decrease in writing size was apparent in both groups (P < .001) and the difference in variability of amplitude between cued and uncued writing disappeared. In addition, the writing speed of controls decreased when the cue was present. CONCLUSIONS Visual target lines of 1.0 cm improved the writing of sequential loops in contrast to lines spaced at 0.6 cm. These results illustrate that, unlike for gait, visual cueing for fine-motor tasks requires a differentiated approach, taking into account the possible increases of accuracy constraints imposed by cueing.
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Affiliation(s)
| | | | | | | | | | - Wim Vandenberghe
- KU Leuven, Leuven, Belgium University Hospitals Leuven, Leuven, Belgium
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24
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Ehgoetz Martens KA, Ellard CG, Almeida QJ. Anxiety-provoked gait changes are selectively dopa-responsive in Parkinson's disease. Eur J Neurosci 2015; 42:2028-35. [PMID: 25899750 DOI: 10.1111/ejn.12928] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 03/26/2015] [Accepted: 04/17/2015] [Indexed: 12/31/2022]
Abstract
In order to understand how dopamine modulates the effect of anxiety on gait, the goal of this study was to use virtual reality to provoke anxiety in Parkinson's disease (PD) (in both ON and OFF states) and quantify its effect on gait. Seventeen participants with PD and 20 healthy age-matched controls were instructed to walk in a virtual environment in two anxiety-provoking conditions: (i) across a plank that was located on the GROUND and (ii) across an ELEVATED plank. All participants with PD completed this experiment in both the ON and OFF states, and were then striated into groups based on baseline trait anxiety scores for further analyses. Anxiety (skin conductance and self-report) and spatiotemporal aspects of gait were measured. Overall, the ELEVATED condition resulted in greater skin conductance levels and self-reported anxiety levels. Additionally, all participants demonstrated slower gait with increased step-to-step variability when crossing the ELEVATED plank compared with the plank on the GROUND. The results showed that dopaminergic treatment selectively improved gait in only the highly anxious PD group, by significantly improving velocity, step length, step time and step-to-step variability specifically when walking across the ELEVATED plank (ON vs. OFF comparison). In conclusion, only highly trait anxious participants with PD benefitted from dopaminergic treatment, specifically when walking in the anxiety-provoking environment. Improvements to gait during anxious walking might be a result of dopaminergic medication acting in two ways: (i) improving the basal ganglia's capacity to process information and (ii) reducing the load from anxiety and subsequently making more resources available to effectively process other competing inputs.
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Affiliation(s)
- Kaylena A Ehgoetz Martens
- Sun Life Financial Movement Disorders Research and Rehabilitation Centre, Wilfrid Laurier University, 75 University Avenue West Waterloo, ON N2L 3C5, Canada.,Cognitive Neuroscience, Department of Psychology, University of Waterloo, Waterloo, ON, Canada
| | - Colin G Ellard
- Cognitive Neuroscience, Department of Psychology, University of Waterloo, Waterloo, ON, Canada
| | - Quincy J Almeida
- Sun Life Financial Movement Disorders Research and Rehabilitation Centre, Wilfrid Laurier University, 75 University Avenue West Waterloo, ON N2L 3C5, Canada
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25
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Virtually-induced threat in Parkinson's: Dopaminergic interactions between anxiety and sensory-perceptual processing while walking. Neuropsychologia 2015; 79:322-31. [PMID: 26004056 DOI: 10.1016/j.neuropsychologia.2015.05.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 05/18/2015] [Accepted: 05/20/2015] [Indexed: 11/20/2022]
Abstract
Research evidence has suggested that anxiety influences gait in PD, with an identified dopa-sensitive gait response in highly anxious PD. It has been well-established that accurate perception of the environment and sensory feedback is essential for gait. Arguably since sensory and perceptual deficits have been noted in PD, anxiety has the potential to exacerbate movement impairments, since one might expect that reducing resources needed to overcome or compensate for sensory-perceptual deficits may lead to even more severe gait impairments. It is possible that anxiety in threatening situations might consume more processing resources, limiting the ability to process information about the environment or one's own movement (sensory feedback) especially in highly anxious PD. Therefore, the current study aimed to (i) evaluate whether processing of threat-related aspects of the environment was influenced by anxiety, (ii) evaluate whether anxiety influences the ability to utilize sensory feedback in PD while walking in threatening situations, and (iii) further understand the role of dopaminergic medication on these processes in threatening situations in PD. Forty-eight participants (24 HC; 12 Low Anxious [LA-PD], 12 Highly Anxious [HA-PD]) completed 20 walking trials in virtual reality across a plank that was (i) located on the ground (GROUND) (ii) located above a deep pit (ELEVATED); while provided with or without visual feedback about their lower limbs (+VF; -VF). After walking across the plank, participants were asked to judge the width of the plank they had just walked across. The plank varied in size from 60-100 cm. Both ON and OFF dopaminergic medication states were evaluated in PD. Gait parameters, judgment error and self-reported anxiety levels were measured. Results showed that HA-PD reported greater levels of anxiety overall (p<0.001) compared to HC and LA-PD, and all participants reported greater anxiety during the ELEVATED condition compared to GROUND (p=0.01). PD had similar judgment error as HC. Additionally, medication state did not significantly influence judgment error in PD. More importantly, HA-PD were the only group that did not adjust their step width when feedback was provided during the GROUND condition. However, medication facilitated a reduction in ST-CV when visual feedback was available only in the HA-PD group. Therefore, the current study provides evidence that anxiety may interfere with information processing, especially utilizing sensory feedback while walking. Dopaminergic medication appears to improve utilization of sensory feedback in stressful situations by reducing anxiety and/or improving resource allocation especially in those with PD who are highly anxious.
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