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Wang Y, Liu C, Zheng W, Li M, Li X. Three hertz orthostatic tremor as "red flag sign" candidate for multiple system atrophy. Neurol Sci 2024:10.1007/s10072-024-07762-8. [PMID: 39302553 DOI: 10.1007/s10072-024-07762-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 09/03/2024] [Indexed: 09/22/2024]
Abstract
AIM This study investigates the potential of 3-Hz orthostatic tremor (OT) as a diagnostic red-flag sign for differentiating multiple system atrophy (MSA) from Parkinson's disease (PD). PATIENTS AND METHODS A total of 615 PD patients and 234 MSA patients (120 MSA-P and 114 MSA-C) participated. OT at ~ 3 Hz and other frequencies was identified through rhythmic postural sway on the stabilogram map and confirmed by fast Fourier transform (FFT) analysis. Extensive assessment of OT occurrence, preferential stance conditions, sway direction, frequency spectrum, and intensity was performed and compared between the two diseases. RESULTS Significant differences in OT features were observed. In PD, 104 patients (16.9%) exhibited tremors, mainly on a firm platform (79.8%), and preferentially in the medial-lateral direction (59.6%). About 40% of PD-related OT showed double peaks in the FFT map, with a frequency spectrum from 3.3 to 12.4 Hz. MSA tremors were observed in 133 patients (56.8%, including 46 MSA-P and 87 MSA-C patients), occurring after proprioceptive sensory input deprivation (94.7%). OT in MSA occurred exclusively in the anterior-posterior direction (100%), with no sub- or ultra-harmonics in the FFT map. Binominal logistic regression analyses demonstrated that frequency and stance conditions independently contributed to differentiating PD- and MSA-related OT. The 3-Hz tremor exhibited a sensitivity of 0.568, perfect specificity (1), an approximate negative predictive value of 0.8592, and a positive predictive value of 1 for MSA identification. CONCLUSIONS This study establishes the 3-Hz orthostatic tremor as a promising red flag sign for MSA identification.
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Affiliation(s)
- Yuzhou Wang
- Department of Neurology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Churong Liu
- Institute for Brain Research and Rehabilitation, South China Normal University, Guangzhou, China
- Department of Neurorehabilitation, Guangdong 999 Brain Hospital, Guangzhou, China
| | - Wenhua Zheng
- Institute for Brain Research and Rehabilitation, South China Normal University, Guangzhou, China
- Department of Neurorehabilitation, Guangdong 999 Brain Hospital, Guangzhou, China
| | - Mengyun Li
- Institute for Brain Research and Rehabilitation, South China Normal University, Guangzhou, China
- Department of Neurorehabilitation, Guangdong 999 Brain Hospital, Guangzhou, China
| | - Xiaodi Li
- Institute for Brain Research and Rehabilitation, South China Normal University, Guangzhou, China.
- Department of Neurology, Guangdong 999 Brain Hospital, Guangzhou, China.
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Fujii S, Takamura Y, Ikuno K, Morioka S, Kawashima N. A comprehensive multivariate analysis of the center of pressure during quiet standing in patients with Parkinson's disease. J Neuroeng Rehabil 2024; 21:59. [PMID: 38654376 PMCID: PMC11036778 DOI: 10.1186/s12984-024-01358-1] [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: 11/28/2023] [Accepted: 04/12/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND We hypothesized that postural instability observed in individuals with Parkinson's disease (PD) can be classified as distinct subtypes based on comprehensive analyses of various evaluated parameters obtained from time-series of center of pressure (CoP) data during quiet standing. The aim of this study was to characterize the postural control patterns in PD patients by performing an exploratory factor analysis and subsequent cluster analysis using CoP time-series data during quiet standing. METHODS 127 PD patients, 47 aged 65 years or older healthy older adults, and 71 healthy young adults participated in this study. Subjects maintain quiet standing for 30 s on a force platform and 23 variables were calculated from the measured CoP time-series data. Exploratory factor analysis and cluster analysis with a Gaussian mixture model using factors were performed on each variable to classify subgroups based on differences in characteristics of postural instability in PD. RESULTS The factor analysis identified five factors (magnitude of sway, medio-lateral frequency, anterio-posterior frequency, component of high frequency, and closed-loop control). Based on the five extracted factors, six distinct subtypes were identified, which can be considered as subtypes of distinct manifestations of postural disorders in PD patients. Factor loading scores for the clinical classifications (younger, older, and PD severity) overlapped, but the cluster classification scores were clearly separated. CONCLUSIONS The cluster categorization clearly identifies symptom-dependent differences in the characteristics of the CoP, suggesting that the detected clusters can be regarded as subtypes of distinct manifestations of postural disorders in patients with PD.
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Affiliation(s)
- Shintaro Fujii
- Graduate School of Health Sciences, Kio University, Nara, Japan
- Department of Rehabilitation, Nishiyamato Rehabilitation Hospital, Nara, Japan
| | - Yusaku Takamura
- Department of Rehabilitation for Movement Functions, Research Institute of National Rehabilitation Center for Persons with Disabilities, 4-1 Namiki, Tokorozawa, Saitama, 359-0042, Japan
| | - Koki Ikuno
- Department of Rehabilitation, Nishiyamato Rehabilitation Hospital, Nara, Japan
| | - Shu Morioka
- Graduate School of Health Sciences, Kio University, Nara, Japan
- Neurorehabilitation Research Center, Kio University, Nara, Japan
| | - Noritaka Kawashima
- Department of Rehabilitation for Movement Functions, Research Institute of National Rehabilitation Center for Persons with Disabilities, 4-1 Namiki, Tokorozawa, Saitama, 359-0042, Japan.
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Braz de Oliveira MP, Rigo Lima C, da Silva SLA, Firmino Vaz Figueira EC, David Truax B, Smaili SM. Effect of aquatic exercise programs according to the International Classification of Functionality, Disability and Health domains in individuals with Parkinson's disease: a systematic review and meta-analysis with GRADE quality assessment. Disabil Rehabil 2024; 46:429-442. [PMID: 36644928 DOI: 10.1080/09638288.2022.2164800] [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: 05/19/2022] [Accepted: 12/30/2022] [Indexed: 01/17/2023]
Abstract
PURPOSE To investigate the effects of aquatic exercise programs (AEP) in body structure and function, activity, and participation outcomes in individuals with Parkinson's disease (PD) with mild to moderate disability levels. METHODS Six databases were searched from inception until November 2022. Randomized clinical trials that used AEP alone, AEP combined and/or compared two types of AEP were included. The quality of evidence was assessed by the GRADE approach and the standardized mean differences (SMD) were calculated the meta-analysis. RESULTS Twelve studies (n = 380) were included. AEP alone was superior to active control in improving body structure and function outcome: postural balance (low evidence, SMD = 0.47, p = 0.02). No statistically significant differences were found for the other body structure and function outcomes: lower limb muscle strength (p = 0.14) and depressive symptoms (p = 0.79), activity outcomes: mobility (p = 0.32) and participation outcomes: quality of life (p = 0.05). AEP combined showed no statistically significant difference for the outcomes of body structure and function: postural balance (p = 0.11) and activity: mobility (p = 0.21) when compared to active control. CONCLUSION AEP showed positive effects on body structure and function outcome (postural balance) in individuals with PD with mild to moderate disability levels while, no significant improvements were noticed for activity and participation outcomes.IMPLICATIONS FOR REHABILITATIONOur findings indicate that aquatic exercise programs (AEP) lead to significant improvements on body structure and function (i.e., postural balance) in individuals with Parkinson's disease (PD).The AEP evaluated in this study implemented postural balance, gait, single and double training, as well as aerobic exercises, trunk mobility exercises, and Ai Chi.The average duration, frequency, and total time implemented were 50 minutes, three times a week, for seven weeks, respectively.Considering the potential benefits identified in this study, AEP can be recommended as an adjunct treatment strategy for individuals with PD.Additionally, the use of the International Classification of Functionality, Disability and Health on the development of rehabilitation treatment plans is advised.
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Affiliation(s)
- Marcos Paulo Braz de Oliveira
- Department of Physical Therapy, Healthy Aging Research Laboratory, Federal University of São Carlos, São Paulo, Brazil
| | - Carla Rigo Lima
- Department of Physical Therapy, Mechanisms of Spinal Manual Therapy Laboratory, The University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Brendon David Truax
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Suhaila Mahmoud Smaili
- Department of Physical Therapy, Neurofunctional Physical Therapy Research Group, State University of Londrina, Londrina, Brazil
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Wang IL, Chen YM, Yao S, Su Y, Mündel T, Lei TH. Whole-body passive heating at moderate hyperthermic state impairs static and dynamic balance in healthy females. Gait Posture 2024; 107:199-206. [PMID: 37852885 DOI: 10.1016/j.gaitpost.2023.10.004] [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: 04/14/2023] [Revised: 08/28/2023] [Accepted: 10/02/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Whether static and dynamic balances can be impaired with increasing core temperature in female participants remains unknown. PURPOSE We tested the hypothesis that static and dynamic balances can be further impaired with systematic increases of core temperature by Δ1 °C and Δ 2 °C using whole-body passive heating. METHOD Eighteen female participants underwent a control trial (Con) and two progressive passive heating trials with Δ 1 °C and Δ 2 °C increase of oral temperature (TOral) using 45 °C water bath. In each trial, we assessed static balance with both eye open and closed and assessed dynamic balance using obstacle crossing at 10 %, 20 % and 30 % of the participant's leg length. RESULTS Static balance was not different between Con and Δ1 °C but was different between Δ1 °C and Δ 2 °C in an eye closed condition. Furthermore, Δ 2 °C greatly impaired both static and dynamic balances when compared to Con. The joint angles and toe clearance increased while leading heel-obstacle distance decreased during crossing obstacles at the height of 20 % and 30 % leg length with leading limbs in the Δ2 °C compared to Δ 1 °C and Con (All P < 0.05). However, no differences in joint kinematics and toe clearance with trailing limbs were observed (All P > 0.05). CONCLUSION In female participants, static and dynamic balances only became impaired when TOral increased 2 °C from baseline.
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Affiliation(s)
- I-Lin Wang
- College of Physical Education, Hubei Normal University, Huangshi, China
| | - Yi-Ming Chen
- Department of Food Science, Fu Jen Catholic University, Taipei, Taiwan
| | - Shun Yao
- Graduate Institute, Jilin Sport University, Changchun, China
| | - Yu Su
- Graduate Institute, Jilin Sport University, Changchun, China
| | - Toby Mündel
- College of Physical Education, Hubei Normal University, Huangshi, China; Department of Kinesiology, Brock University, St. Catharines, Canada
| | - Tze-Huan Lei
- College of Physical Education, Hubei Normal University, Huangshi, China.
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Santos GV, d'Alencar MS, Helene AF, Roque AC, Miranda JGV, Piemonte MEP. A non-expensive bidimensional kinematic balance assessment can detect early postural instability in people with Parkinson's disease. Front Neurol 2023; 14:1243445. [PMID: 38046589 PMCID: PMC10693416 DOI: 10.3389/fneur.2023.1243445] [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: 06/20/2023] [Accepted: 10/04/2023] [Indexed: 12/05/2023] Open
Abstract
BackgroundPostural instability is a debilitating cardinal symptom of Parkinson’s disease (PD). Its onset marks a pivotal milestone in PD when balance impairment results in disability in many activities of daily living. Early detection of postural instability by non-expensive tools that can be widely used in clinical practice is a key factor in the prevention of falls in widespread population and their negative consequences.ObjectiveThis study aimed to investigate the effectiveness of a two-dimensional balance assessment to identify the decline in postural control associated with PD progression.MethodsThis study recruited 55 people with PD, of which 37 were men. Eleven participants were in stage I, twenty-three in stage II, and twenty-one in stage III. According to the Hoehn and Yahr (H&Y) rating scale, three clinical balance tests (Timed Up and Go test, Balance Evaluation Systems Test, and Push and Release test) were carried out in addition to a static stance test recorded by a two-dimensional movement analysis software. Based on kinematic variables generated by the software, a Postural Instability Index (PII) was created, allowing a comparison between its results and those obtained by clinical tests.ResultsThere were differences between sociodemographic variables directly related to PD evolution. Although all tests were correlated with H&Y stages, only the PII was able to differentiate the first three stages of disease evolution (H&Y I and II: p = 0.03; H&Y I and III: p = 0.00001; H&Y II and III: p = 0.02). Other clinical tests were able to differentiate only people in the moderate PD stage (H&Y III).ConclusionBased on the PII index, it was possible to differentiate the postural control decline among the first three stages of PD evolution. This study offers a promising possibility of a low-cost, early identification of subtle changes in postural control in people with PD in clinical practice.
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Affiliation(s)
- Gabriel Venas Santos
- Department of Physical Therapy, Speech Therapy and Occupational Therapy, Faculty of Medical Science, University of São Paulo, São Paulo, Brazil
| | - Matheus Silva d'Alencar
- Department of Physical Therapy, Speech Therapy and Occupational Therapy, Faculty of Medical Science, University of São Paulo, São Paulo, Brazil
| | - Andre Frazão Helene
- Department of Physiology, Institute of Biosciences, University of São Paulo, São Paulo, Brazil
| | - Antonio C. Roque
- Department of Physics, School of Philosophy, Sciences and Letters of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Maria Elisa Pimentel Piemonte
- Department of Physical Therapy, Speech Therapy and Occupational Therapy, Faculty of Medical Science, University of São Paulo, São Paulo, Brazil
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Bao W, Tan Y, Yang Y, Chen K, Liu J. Correlation of balance posturographic parameters during quiet standing with the berg balance scale in patients with parkinson's disease. BMC Neurol 2023; 23:362. [PMID: 37803250 PMCID: PMC10557353 DOI: 10.1186/s12883-023-03386-1] [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: 04/25/2023] [Accepted: 09/12/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) is often clinically associated with posture instability and more easily falling. The Berg balance scale is a clinical indicator commonly used to subjectively evaluate a patient's balance ability. Meanwhile, computerized force platforms have been used in research on postural control. The various parameters obtained from posturography are interpreted to assess balance ability. The present study aims to explore the correlations between posturographic variables and the BBS, and furthermore to efficiently evaluate postural instability and fall risk of early and moderate PD patients. METHODS A total of 46 PD patients were involved in the experiment. Patients were asked to perform BBS tests and force platform tests under eye open (EO) and eye closed (EC) conditions. The recorded COP signal was analyzed with the time domain statistical method, the frequency domain method of Power Spectral Density (PSD), and structural methods of Stabilogram Diffusion Analysis (SDA), Sway Density Plot (SDP) to retrieve different posturographic variables. The correlation between posturographic variables under EO and EC conditions with BBS was compared statistically. The significantly correlated posturographic parameters were then applied to analyze posturographic differences between different groups: faller vs. non-faller (patients with/without a history of falls in the past 12 months). RESULTS Among the different posturographic parameters, the prediction ellipse area, the slope of the regression line at a high-frequency band of PSD in the medial-lateral (ML) direction, the crossover point of the regression lines of SDA in the anterior-posterior (AP) direction, and the distance between successive peaks of SDP had significant correlations with BBS. These selected BBS-related parameters also showed significant differences between faller and non-faller. The selected posturographic parameters can be used as effective indicators to evaluate the balance ability of Parkinson's disease patients.
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Affiliation(s)
- Wei Bao
- School of Mechanical Engineering, Hangzhou Dianzi University, Hangzhou, 310018, Zhejiang, China
| | - Yuyan Tan
- Department of Neurology, Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Ying Yang
- School of Mechanical Engineering, Hangzhou Dianzi University, Hangzhou, 310018, Zhejiang, China
| | - Kai Chen
- School of Mechanical Engineering, Hangzhou Dianzi University, Hangzhou, 310018, Zhejiang, China.
| | - Jun Liu
- Department of Neurology, Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
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Wodarski P, Jurkojć J, Michalska J, Kamieniarz A, Juras G, Gzik M. Balance assessment in selected stages of Parkinson's disease using trend change analysis. J Neuroeng Rehabil 2023; 20:99. [PMID: 37528430 PMCID: PMC10394805 DOI: 10.1186/s12984-023-01229-1] [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: 02/21/2023] [Accepted: 07/28/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Balance disorders in patients diagnosed with Parkinson's disease (PD) are associated with a change in balance-keeping strategy and reflex disorders which regulate the maintenance of vertical body posture. Center of foot pressure (COP) displacement signals were analyzed during quiet standing experiments to define such changes. The research aimed to apply stock exchange indices based on the trend change analyses to the assessment of a level of the Parkinson disease progression on the grounds of the analysis of the COP signals. METHODS 30 patients in two stages of PD, 40 elderly participants, and 20 individuals at a young age were studied. Each person was subjected to 3 measurements with open and closed eyes. A technical analysis of the COP displacement signal was performed, and the following quantities were determined: indices related to the number of trend changes (TCI), indices defining a mean time (TCI_dT), and mean displacement (TCI_dS) and mean velocity (TCI_dV) between such changes. RESULTS The results indicate a higher TCI value for PD than for aged-matched control group (p < 0.05). In the case of PD patients, there was also an increase in the TCI_dS value by 2-5 mm, which mainly contributed to the increase in TCI_dV. Statistically significant differences for the TCI_dT values occurred between all groups in which differences in the average COP velocity were noted. CONCLUSIONS The TCI and TCI_dV results obtained for the healthy participants enabled the development of indices supporting PD diagnostics. The causes of the TCI_dV changes in patients were determined, i.e., whether they resulted from an increase in the TCI_dT or TCI_dS between the moments of trend changes indicated by the developed algorithm. The developed methodology provides new information on the impact of PD on the strategy of maintaining balance, which was impossible to obtain using currently used analyses. Trial registration The conducted research is an observational study and does not include a health care intervention. Participants gave their consent to participate in the research and the procedure was approved by the Institutional Bioethics Committee.
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Affiliation(s)
- Piotr Wodarski
- Department of Biomechatronics, Faculty of Biomedical Engineering, Silesian University of Technology, Gliwice, Poland
| | - Jacek Jurkojć
- Department of Biomechatronics, Faculty of Biomedical Engineering, Silesian University of Technology, Gliwice, Poland
| | - Justyna Michalska
- Department of Human Motor Behavior, Institute of Sport Sciences, Academy of Physical Education in Katowice, Katowice, Poland
| | - Anna Kamieniarz
- Department of Human Motor Behavior, Institute of Sport Sciences, Academy of Physical Education in Katowice, Katowice, Poland
| | - Grzegorz Juras
- Department of Human Motor Behavior, Institute of Sport Sciences, Academy of Physical Education in Katowice, Katowice, Poland
| | - Marek Gzik
- Department of Biomechatronics, Faculty of Biomedical Engineering, Silesian University of Technology, Gliwice, Poland
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Improvement of Balance, Motor Aspects, and Activities of Daily Living in Parkinson's Disease after a Sequential Multimodal Aquatic- and Land-Based Intervention Program. Rehabil Res Pract 2023; 2023:2762863. [PMID: 36654865 PMCID: PMC9842425 DOI: 10.1155/2023/2762863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 11/29/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023] Open
Abstract
Parkinson's disease (PD) is a neurodegenerative, with heterogeneous clinical conditions and motor changes that reduce functioning. Postural instability is one of the motor aspects of disease progression, with a potential increase in the risk of falls, consequently affecting the activities of daily living (ADL). The objective of this study was to verify the influence of a multimodal intervention program (MIP) sequentially applied in aquatic- (AEs) and land-based environments (LEs) on balance, postural control, motor activities, and ADL in people with PD. It is an interventional clinical study with patients in stages 1 to 4 in the Hoehn and Yahr scale, assessed with Berg Balance Scale (BBS), Mini-Balance Evaluation System Test (Mini-BESTest), Unified Parkinson's Disease Rating Scale (UPDRS) II and III, Dynamic Gait Index (DGI), and quiet stance (QS) analysis in a force platform. The MIP was conducted sequentially with aquatic- (AIs) and land-based interventions (LIs) for 12 weeks each, twice a week, each session lasting 1 hour, and a 12-week interval between interventions. The comparison analysis was made with Friedman ANOVA, and the multiple comparisons with Wilcoxon signed-rank, Bonferroni correction, and effect size (r). The sample comprised 18 people with PD (66.83 ± 11.74 years). The AI and the full intervention (FI) had a large effect according to BBS. With Mini-BESTest, the LI and FI had a large effect. According to UPDRS II, the MIP improved ADL after LI, with a medium effect, and the motor aspects of UPDRS III improved after LI and FI, with a large effect. DGI was not sensitive in the analyses, with a ceiling effect after FI. No differences were identified in QS analyses. This research identified improved balance, ADL, and motor aspects in people with PD after sequential MIP in AI and LI, indicating that land-based and aquatic interventions are complementary and advantageous to people with PD.
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Bao W, Li P, Yang Y, Chen K, Liu J. Dynamic postural balance indices can help discriminate between patients with multiple system atrophy and Parkinson's disease. Front Neurol 2023; 13:1089439. [PMID: 36698891 PMCID: PMC9868697 DOI: 10.3389/fneur.2022.1089439] [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: 11/04/2022] [Accepted: 12/09/2022] [Indexed: 01/11/2023] Open
Abstract
Background Patients with Parkinson's disease (PD) and those with multiple system atrophy (MSA) show similar symptoms but have different clinical treatments. It will be helpful to discriminate between these two kinds of patients at an early or middle stage. The purpose of this study is to highlight the differences in posturographic characterization between patients with PD and those with MSA during quiet standing and perturbed standing. Methods A total of clinically diagnosed 42 patients with PD and 32 patients with MSA participated in the experiment. Patients were asked to first stand on a static balance force platform and then on a dynamic balance (medial-lateral rocker) force platform to measure the center of pressure (COP) trajectory during an eyes-open (EO) state. The posturographic parameters were obtained under the two standing conditions for statistical analysis. Results Four posturographic variables were calculated and analyzed, namely, the standard deviation of COP position (SD), sway path of COP position (SP), an elliptical area covering the 95% COP position trajectory (EA), sway path of COP position (SP), and integral area of the power spectral density at 0-0.5 Hz frequency band (PSD). Except for variable EA, the other three variables are all in the medial-lateral (ML) direction. In the static balance experiment, there were no significant differences between the four variables between patients with PD and those with MSA. However, in the dynamic balance experiment, the obtained four variables all presented significant differences between patients with PD and those with MSA. Conclusion The dynamic posturographic variables with significant differences between patients with PD and those with MSA imply that patients with MSA have worse postural control ability in the medial-lateral (ML) direction compared to patients with PD. The obtained dynamic indices may help supplemental clinical evaluation to discriminate between patients with MSA and those with PD.
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Affiliation(s)
- Wei Bao
- School of Mechanical Engineering, Hangzhou Dianzi University, Hangzhou, Zhejiang, China
| | - Puyu Li
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Yang
- School of Mechanical Engineering, Hangzhou Dianzi University, Hangzhou, Zhejiang, China
| | - Kai Chen
- School of Mechanical Engineering, Hangzhou Dianzi University, Hangzhou, Zhejiang, China,*Correspondence: Kai Chen ✉
| | - Jun Liu
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,Jun Liu ✉
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Sebastia-Amat S, Tortosa-Martínez J, Pueo B. The Use of the Static Posturography to Assess Balance Performance in a Parkinson's Disease Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:981. [PMID: 36673738 PMCID: PMC9859212 DOI: 10.3390/ijerph20020981] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/29/2022] [Accepted: 12/31/2022] [Indexed: 06/17/2023]
Abstract
The literature has shown contradictory results so far about the use of posturography, especially static posturography, to evaluate balance performance in Parkinson’s disease (PD) populations. This study aimed to investigate the use of static posturography as a valid method to evaluate balance in a PD population. Fifty-two participants diagnosed with PD (Hoehn & Yahr stage: 1−3) were included in this cross-sectional study. All participants completed the following assessments: Hoehn and Yahr scale, Movement Disorder Society-Unified Parkinson’s Disease Rating Scale, Tinetti Scale, Berg Balance Scale, Activities-specific Balance Confidence scale, Timed Up and Go test, and Functional Reach Test. Sway parameters were analyzed with a baropodometric platform, under eyes open (EO) and eyes closed (EC) conditions, in a bipodal stance. Small to large correlations were observed between clinical balance tests and static posturography parameters, although the majority of these parameters correlated moderately. Considering posturographic variables, the highest correlation values were detected for total excursion (TE), mean velocity (MV), mean (X-mean), and root-mean-square (X-RMS) displacements in the medio-lateral directions. It was observed that posturographic parameters worsened as the disease progresses, although differences were only significant between the stages 1 and 3 in the H&Y scale (p < 0.05). Regarding the test condition, the visual deprivation worsened significantly all the static posturography parameters (p < 0.05), except the antero-posterior mean displacement (Y-Mean). Comparing visual conditions, the EC presented slightly higher correlation values with the clinical balance tests. Static posturography could be used as an objective complementary tool to clinical balance tests in order to assess and control balance performance, mainly to detect postural instability problems.
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Samsonova TV, Krivonogov VA, Nazarov SB, Ryl’skaya YA. Assessment of postural control in children. ROSSIYSKIY VESTNIK PERINATOLOGII I PEDIATRII (RUSSIAN BULLETIN OF PERINATOLOGY AND PEDIATRICS) 2022. [DOI: 10.21508/1027-4065-2022-67-5-27-33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The relevance of the study is due to the high incidence of postural control impairment in patients with neurological diseases and lack of common approaches to their diagnosing in children. In this article we show the main stages in the formation of postural control and mechanisms of balance maintaining in childhood. We assessed the information content of existing clinical scales used to study components of postural balance in children in clinical practice. Also, we studied the diagnostic significance of functional methods for assessing postural control. Particular attention we paid to the study of the diagnostic significance of computer posturography (stabilometry) and accelerometry. We identified the main clinical and functional diagnostic markers of postural imbalance in children of different age and nosological groups. Further research in this area will make it possible to develop the most objective criteria for impaired postural control in childhood, which will increase the effectiveness of treatment and rehabilitation measures.
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Affiliation(s)
- T. V. Samsonova
- Gorodkov Ivanovo Research Institute of Maternity and Childhood
| | | | - S. B. Nazarov
- Gorodkov Ivanovo Research Institute of Maternity and Childhood
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Da Silva KG, Nuvolini RA, Bacha JMR, De Freitas TB, Doná F, Torriani-Pasin C, Pompeu JE. Comparison of the Effects of an Exergame-Based Program with Conventional Physiotherapy Protocol Based on Core Areas of the European Guideline on Postural Control, Functional Mobility, and Quality of Life in Patients with Parkinson's Disease: Randomized Clinical Trial. Games Health J 2022; 12:228-241. [PMID: 36206023 DOI: 10.1089/g4h.2022.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Impairment of postural control and functional mobility are debilitating symptoms of Parkinson's disease (PD). In addition to limiting performance in activities of daily living, it is associated with a higher prevalence of falls in this population. Particularly, dysfunction in postural control does not respond to dopaminergic replacement therapy, but physiotherapy can improve this outcome in patients with PD. Objective: The aim of this study was to analyze the effects of training based on Kinect Adventures games compared with a conventional physiotherapy protocol based on the core areas of the European physiotherapy guideline in patients with PD on postural control, functional mobility, self-perception of confidence in the balance, quality of life (QoL), lower limb muscle strength, transfer skill and motor function, as well as to observe adherence and safety interventions. Methods: Thirty-eight patients diagnosed with idiopathic PD were randomized into two groups, and performed 14 training sessions, twice a week for 60 minutes. The primary outcome assessed postural control using the Mini-Balance Evaluation Systems Test (Mini-BESTest). The following were evaluated as secondary outcomes: limit of stability; balance functional reserve and center of pressure area by computerized posturography; functional mobility by the Timed Up and Go test; self-confidence in balance through the Activities-specific Balance Confidence scale; QoL through the Parkinson's Disease Questionnaire; lower limb muscle strength by the Five Times Sit-To-Stand test; and motor function by the Unified Parkinson's Disease Rating Scale. Results: Patients completed training sessions with high rates of safety and adherence. After training, there was a significant improvement in postural control, motor function, and QoL. Conclusion: Both interventions proved to be safe, applicable, and effective to improve postural control, QoL, and motor function in patients with PD. However, there was no difference between the effects of Kinect Adventures games and conventional physiotherapeutic protocol in patients with PD. Brazilian Registry of Clinical Trials (RBR-27kqv5).
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Affiliation(s)
- Keyte Guedes Da Silva
- Department of Physiotherapy, Speech and Occupational Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Rosemeyre Alcarde Nuvolini
- Department of Physiotherapy, Speech and Occupational Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Jéssica Maria Ribeiro Bacha
- Department of Physiotherapy, Speech and Occupational Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Tatiana Beline De Freitas
- Motor Behavior Laboratory, Department of Biodynamics of Human Body Movement, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Flávia Doná
- Department of Sciences of the Human Movement and Rehabilitation, Federal University of São Paulo, São Paulo, Brazil
| | - Camila Torriani-Pasin
- Motor Behavior Laboratory, Department of Biodynamics of Human Body Movement, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - José Eduardo Pompeu
- Department of Physiotherapy, Speech and Occupational Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
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13
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Shah VV, Vitorio R, Hasegawa N, Carlson-Kuhta P, Nutt JG, King LA, Mancini M, Horak FB. Effects of a Cognitively Challenging Agility Boot Camp Program on Balance and Gait in People With Parkinson's Disease: Does Freezing of Gait Status Matter? Neurorehabil Neural Repair 2022; 36:603-612. [PMID: 36004814 DOI: 10.1177/15459683221119757] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIM Individuals with Parkinson's disease (PD) with and without freezing of Gait (FoG) may respond differently to exercise interventions for several reasons, including disease duration. This study aimed to determine whether both people with and without FoG benefit from the Agility Boot Camp with Cognitive Challenges (ABC-C) program. METHODS This secondary analysis of our ABC-C trial included 86 PD subjects: 44 without FoG (PD-FoG) and 42 with FoG (PD + FoG). We collected measures of standing sway balance, anticipatory postural adjustments, postural responses, and a 2-minute walk with and without a cognitive task. Two-way repeated analysis of variance, with disease duration as covariate, was used to investigate the effects of ABC-C program. Effect sizes were calculated using standardized response mean (SRM) for PD-FoG and PD + FoG, separately. RESULTS The ABC-C program was effective in improving gait performance in both PD-FoG and PD + FoG, even after controlling for disease duration. Specifically, dual-task gait speed (P < .0001), dual-cost stride length (P = .012), and these single-task measures: arm range of motion (P < .0001), toe-off angle (P = .005), gait cycle duration variability (P = .019), trunk coronal range of motion (P = .042), and stance time (P = .046) improved in both PD-FoG and PD + FoG. There was no interaction effect between time (before and after exercise) and group (PD-FoG/PD + FoG) in all 24 objective measures of balance and gait. Dual-task gait speed improved the most in PD + FoG (SRM = 1.01), whereas single-task arm range of motion improved the most in PD-FoG (SRM = 1.01). CONCLUSION The ABC-C program was similarly effective in improving gait (and not balance) performance in both PD-FoG and PD + FoG.
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Affiliation(s)
- Vrutangkumar V Shah
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Rodrigo Vitorio
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne, UK
| | - Naoya Hasegawa
- Department of Rehabilitation Science, Hokkaido University, Sapporo, Hokkaido, Japan
| | | | - John G Nutt
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Laurie A King
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Martina Mancini
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Fay B Horak
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
- APDM Wearable Technologies, A Clario company, Portland, OR, USA
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Lee J, Yu J, Hong J, Lee D, Kim J, Kim S. The Effect of Augmented Reality-Based Proprioceptive Training Program on Balance, Positioning Sensation and Flexibility in Healthy Young Adults: A Randomized Controlled Trial. Healthcare (Basel) 2022; 10:healthcare10071202. [PMID: 35885731 PMCID: PMC9317612 DOI: 10.3390/healthcare10071202] [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: 05/17/2022] [Revised: 06/16/2022] [Accepted: 06/22/2022] [Indexed: 11/16/2022] Open
Abstract
This study investigates whether Augmented Reality (AR)-based interventions can be as effective as physical therapists (PT) regarding balance, positioning sensation, and flexibility. A sample of 39 regular people who voluntarily participated in this study were randomly distributed into two groups. Then AR was applied in the experimental group and PT was applied in the control group. Variables were measured by Tetrax (static balance), Y-balance test (dynamic balance), CSMI (proprioception), and sit and reach test (flexibility). All measurements were analyzed using paired t-test and independent t-test. The exercise program of this study improved the stability index (ST) of the static balance in both groups after the intervention, and there was a significant difference (p < 0.05) at normal eye close (NC) and Pillow with eye close (PC) positions. Moreover, regarding the case of dynamic balance, there were significant differences in AR and PT groups to reach in all directions (p < 0.05). In the case of positioning sensation, there was no significant difference in both groups (p > 0.05), and there was a significant difference in flexibility (p < 0.05). When comparing the two groups, there was no significant difference in all categories (p > 0.05). As a result, AR can be considered an effective form of therapy and can be selected according to individual conditions.
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Affiliation(s)
- Jaewon Lee
- Correspondence: ; Tel.: +82-10-7390-4699
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Schmidle S, de Crignis AC, Stürzer M, Hermsdörfer J, Jahn K, Krewer C. Influence of stance width on standing balance in healthy older adults. J Neurol 2022; 269:6228-6236. [DOI: 10.1007/s00415-022-11144-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 04/07/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
AbstractPosturography is an objective way to systematically interpret postural control. Recent evidence suggests self-selected stance width when conducting posturography in healthy young participants, as it is easy to perform yet standardized. It is unclear, if this is similarly applicable to healthy older adults which can better serve as comparison group for persons with specific impairments, like Parkinson’s disease, who might have problems with set foot distances. The aim of this study was to investigate the influence of different stance widths on a set of parameters in healthy older adults. Twenty-four healthy elderly (65.6 ± 5.0 years, BMI 26.2 ± 4.5 kg/m2) participated in the study. Posturographic measurement consisted of two tests (body sway, BS; limits of stability, LoS) each assessed in five stance widths on a force platform. A series of time domain and frequency domain parameters, such as BS and LoS range, sample entropy, mean velocity, and balance functional reserve were calculated. Anthropometric parameters and self-selected stance width (mean 17.7 ± 4.7 cm) showed positive correlation. One-way repeated measures MANOVA revealed significant differences between all parameters and foot positions. Except for sample entropy in A-P dimension, univariate analysis showed significant effects of stance widths on the parameters with stronger effects on M-L dimensions. Outcomes acquired in self-selected stance width provide comparable results to standardized stance widths 20 and 30 cm. The recommendation of self-selected stance width can be adopted to older healthy subjects. Furthermore, it reflects a natural stance and includes individual body composition.
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Exley T, Moudy S, Patterson RM, Kim J, Albert MV. Predicting UPDRS Motor Symptoms in Individuals with Parkinsons Disease from Force Plates Using Machine Learning. IEEE J Biomed Health Inform 2022; 26:3486-3494. [PMID: 35259121 DOI: 10.1109/jbhi.2022.3157518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Parkinsons disease (PD) is a neurodegenerative disease that affects motor abilities with increasing severity as the disease progresses. Traditional methods for diagnosing PD include a section where a trained specialist scores qualitative symptoms using the motor subscale of the Unified Parkinsons Disease Rating Scale (UPDRS-III). The aim of this feasibility study was twofold. First, to evaluate quiet standing as an additional, out-of-clinic, objective feature to predict UPDRS-III subscores related to motor symptom severity; and second, to use quiet standing to detect the presence of motor symptoms. Force plate data were collected from 42 PD patients and 43 healthy controls during quiet standing (a task involving standing still with eyes open and closed) as a feasible task in clinics. Predicting each subscore of the UPDRS-III could aid in identifying progression of PD and provide specialists additional tools to make an informed diagnosis. Random Forest feature importance indicated that features correlated with range of center of pressure (i.e. the medial-lateral and anterior-posterior sway) were most useful in the prediction of the top PD prediction subscores of postural stability (r = 0.599; p = 0.014), hand tremor of the left hand (r = 0.650; p = 0.015), and tremor at rest of the left upper extremity (r = 0.703; p = 0.016). Quiet standing can detect body bradykinesia (AUC-ROC = 0.924) and postural stability (AUC-ROC = 0.967) with high predictability. Although there are limited data, these results should be used as a feasibility study that evaluates the predictability of individual UPDRS-III subscores using quiet standing data.
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Allen DD, Gadayan J, Hughes R, Magdalin C, Jang C, Schultz A, Scott K, Vivero L, Lazaro RL, Widener GL. Patterns of balance loss with systematic perturbations in Parkinson's disease and multiple sclerosis. NeuroRehabilitation 2021; 49:607-618. [PMID: 34776428 PMCID: PMC8764603 DOI: 10.3233/nre-210200] [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] [Indexed: 11/25/2022]
Abstract
BACKGROUND: Multiple sclerosis (MS) and Parkinson’s disease (PD) may affect balance differently. However, no studies have compared loss of balance (LOB) patterns following multi-directional perturbations. OBJECTIVE: 1) determine reliability of LOB ratings following standardized manual perturbations; 2) compare LOB ratings in MS, PD, and healthy control (HC) groups following perturbations at upper/lower torso, in anterior/posterior, right/left, and rotational directions. METHODS: 1) reviewers rated videotaped LOB following perturbations applied by 4 clinicians in 6–10 HCs. 2) three groups (64 MS, 42 PD and 32 HC) received perturbations. LOB ratings following perturbations were analyzed using two-factor mixed ANOVAs for magnitude and prevalence. RESULTS: 1) LOB ratings showed moderate to good ICC and good to excellent agreement. 2) MS group showed greater magnitude and prevalence of LOB than PD or HC groups (p < .001). All groups showed greater LOB from right/left versus anterior/posterior perturbations (p < .01). PD showed greater LOB from perturbations at upper versus lower torso; MS and HC showed greater LOB from posterior versus anterior perturbations. CONCLUSIONS: Our reliable rating scale showed differences in patterns of LOB following manual perturbations in MS, PD, and HC. Clinically accessible and reliable assessment of LOB could facilitate targeted perturbation-based interventions and reduce falls in vulnerable populations.
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Affiliation(s)
- Diane D Allen
- Graduate Program in Physical Therapy, University of California San Francisco/San Francisco State University, San Francisco, CA, USA
| | | | | | | | | | - Amy Schultz
- Red Bull Athlete Performance Center, Red Bull Media House, Santa Monica, MA, USA
| | - Kathryn Scott
- Veterans Affairs Rocky Mountain Regional Health Care System, Aurora, CO, USA
| | - Leah Vivero
- Department of Veterans Affairs, Milpitas, CA, USA
| | | | - Gail L Widener
- Physical Therapy, Samuel Merritt University, Oakland, CA, USA
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18
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Klunk D, Woost TB, Fricke C, Classen J, Weise D. Differentiating neurodegenerative parkinsonian syndromes using vestibular evoked myogenic potentials and balance assessment. Clin Neurophysiol 2021; 132:2808-2819. [PMID: 34628341 DOI: 10.1016/j.clinph.2021.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 07/15/2021] [Accepted: 08/07/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Vestibular evoked myogenic potentials (VEMP) were investigated to differentiate between parkinsonian syndromes. We correlated balance and VEMP parameters to investigate the VEMP brainstem circuits as possible origin for postural instability. METHODS We assessed clinical status, ocular and cervical VEMP (oVEMP, cVEMP) and conducted a balance assessment (posturography, Activities-specific Balance Confidence Scale, Berg Balance Scale, modified Barthel Index) in 76 subjects: 30 with Parkinson's disease (PD), 16 with atypical parkinsonism (AP) and 30 healthy controls. VEMP were elicited by using a mini-shaker on the forehead. RESULTS Patients with PD had a prolonged oVEMP n10 in comparison to controls and prolonged p15 compared to controls and AP. Patients with AP showed reduced oVEMP amplitudes compared to PD and controls. CVEMP did not differ between groups. Postural impairment was higher in AP compared to controls and PD, particularly in the rating scales. No correlations between VEMP and posturography were found. A support vector machine classifier was able to automatically classify controls and patient subgroups with moderate to good accuracy based on oVEMP latencies and balance questionnaires. CONCLUSIONS Both oVEMP and posturography, but not cVEMP, may be differentially affected in PD and AP. We did not find evidence that impairment of the cVEMP or oVEMP pathways is directly related to postural impairment. SIGNIFICANCE OVEMP and balance assessment could be implemented in the differential diagnostic work-up of parkinsonian syndromes.
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Affiliation(s)
- Dietrich Klunk
- Department of Neurology, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany; Department of Neurology, Altenburger Land Hospital, Am Waldessaum 10, 04600 Altenburg, Germany
| | - Timo B Woost
- Department of Neurology, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany; Department of Psychiatry and Psychotherapy, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany
| | - Christopher Fricke
- Department of Neurology, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - Joseph Classen
- Department of Neurology, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - David Weise
- Department of Neurology, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany; Department of Neurology, Asklepios Fachklinikum Stadtroda, Bahnhofstraße 1A, 07646 Stadtroda, Germany.
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Sousa LR, Martins BCR, Oliveira LTD, Hallal CZ. O tempo de balanço como variável preditiva da doença de Parkinson. FISIOTERAPIA E PESQUISA 2021. [DOI: 10.1590/1809-2950/20028228012021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Atualmente, a doença de Parkinson (DP) tem seu diagnóstico baseado apenas na observação clínica de uma combinação de sintomas, o que pode levar ao diagnóstico tardio, uma vez que alguns indivíduos podem ter a doença por 5 a 10 anos antes de serem diagnosticados. O objetivo do estudo foi identificar variáveis cinemáticas temporais da marcha capazes de discriminar idosos com e sem DP. 40 indivíduos foram divididos em dois grupos: grupo de idosos sem DP (n=21) e com DP (n=19). Dez ciclos de marcha consecutivos foram obtidos durante a marcha em velocidade de preferência, e utilizados para a análise dos dados. Realizou-se uma análise discriminativa para determinar um modelo preditor de alterações na marcha característico da DP e calculado com base na especificidade e sensibilidade de cada variável analisada, utilizando-se variáveis cinemáticas temporais. A variável com valor discriminativo de sensibilidade e especificidade foi o tempo de balanço, o que pode classificá-la como a variável com grande potencial preditivo da presença ou não da DP; o ponto de corte encontrado para essa variável foi de 0,48segundos. A análise cinemática da marcha permite discriminar um grupo de indivíduos com DP de um grupo de indivíduos saudáveis com alta sensibilidade e especificidade, por meio do tempo de balanço, menor no grupo acometido pela doença (corte de 0,48 segundos).
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Konstantopoulos I, Kafetzakis I, Chatziilias V, Mandalidis D. Fatigue-Induced Inter-Limb Asymmetries in Strength of the Hip Stabilizers, Postural Control and Gait Following a Unilateral Countermovement Vertical Jump Protocol. Sports (Basel) 2021; 9:33. [PMID: 33673474 PMCID: PMC7997463 DOI: 10.3390/sports9030033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/20/2021] [Accepted: 02/23/2021] [Indexed: 12/11/2022] Open
Abstract
It is generally accepted that neuromuscular overload and fatigue of one lower limb can affect the functional ability of the ipsilateral limb, and possibly the contralateral limb, increasing the likelihood of injury. The purpose of the current study was to examine the effect of a unilateral countermovement vertical jump (UCVJ) fatigue protocol on the neuromuscular function of the ipsilateral as well as the contralateral lower limb. The isometric strength of the hip stabilizers, postural control via posturographic analysis during the Y-Balance-Test (YBT), and the stance-phase-of-gait were assessed in 24 healthy physical active males and females before and after execution of a UCVJ fatigue protocol. The fatigue protocol included 5 sets of 20 maximum UCVJs performed on the supportive leg, with a 30-s break between sets. Following a 16.8% decline in vertical jump performance and an associated 2.3-fold increase in perceived exertion, our findings revealed significant post-fatigue inter-limb differences regarding postural control. The post-fatigue inter-limb differences regarding the isometric strength of the hip stabilizers and the stance-phase-of-gait parameters were not significant. Our findings showed that a 100 UCVJs session is likely to induce significant inter-limb differences in postural control, possibly increasing the risk of lower limb injury.
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Affiliation(s)
| | | | | | - Dimitris Mandalidis
- Sports Physical Therapy Laboratory, Department of Physical Education and Sports Science, School of Physical Education and Sports Science, National and Kapodistrian University of Athens, 172 37 Athens, Greece; (I.K.); (I.K.); (V.C.)
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21
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Moraca GAG, Beretta VS, Dos Santos PCR, Nóbrega-Sousa P, Orcioli-Silva D, Vitório R, Gobbi LTB. Center of pressure responses to unpredictable external perturbations indicate low accuracy in predicting fall risk in people with Parkinson's disease. Eur J Neurosci 2021; 53:2901-2911. [PMID: 33561905 DOI: 10.1111/ejn.15143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 11/29/2022]
Abstract
Falls are associated with impairment in postural control in people with Parkinson's disease (PwPD). We aimed to predict the fall risk through models combining postural responses with clinical and cognitive measures. Also, we compared the center of pressure (CoP) between PwPD fallers and non-fallers after unpredictable external perturbations. We expected that CoP parameters combined with clinical and cognitive measures would predict fall risk. Seventy-five individuals participated in the study. CoP parameters were measured during postural responses through five trials with unpredictable translations of the support-surface in posterior direction. Range and peak of CoP were analyzed in two periods: early and late responses. Time to peak (negative peak) and recovery time were analyzed regardless of the periods. Models included the CoP parameters in early (model 1), late responses (model 2), and temporal parameters (model 3). Clinical and cognitive measures were entered into all models. Twenty-nine participants fell at least once, and 46 PwPD did not fall during 12 months following the postural assessment. Range of CoP in late responses was associated with fall risk (p = .046). However, although statistically non-significant, this parameter indicated low accuracy in predicting fall risk (area under the curve = 0.58). Fallers presented a higher range of CoP in early responses than non-fallers (p = .033). In conclusion, although an association was observed between fall risk and range of CoP in late responses, this parameter indicated low accuracy in predicting fall risk in PwPD. Also, fallers demonstrate worse postural control during early responses after external perturbations than non-fallers, measured by CoP parameters.
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Affiliation(s)
- Gabriel Antonio Gazziero Moraca
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Rio Claro, Brazil
| | - Victor Spiandor Beretta
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Rio Claro, Brazil.,Graduate Program in Movement Sciences, São Paulo State University (Unesp), Rio Claro, Brazil
| | - Paulo Cezar Rocha Dos Santos
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Rio Claro, Brazil.,Graduate Program in Movement Sciences, São Paulo State University (Unesp), Rio Claro, Brazil.,Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Priscila Nóbrega-Sousa
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Rio Claro, Brazil.,Graduate Program in Movement Sciences, São Paulo State University (Unesp), Rio Claro, Brazil
| | - Diego Orcioli-Silva
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Rio Claro, Brazil.,Graduate Program in Movement Sciences, São Paulo State University (Unesp), Rio Claro, Brazil
| | - Rodrigo Vitório
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Rio Claro, Brazil.,Graduate Program in Movement Sciences, São Paulo State University (Unesp), Rio Claro, Brazil.,Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Lilian Teresa Bucken Gobbi
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Rio Claro, Brazil.,Graduate Program in Movement Sciences, São Paulo State University (Unesp), Rio Claro, Brazil
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Kamieniarz A, Michalska J, Marszałek W, Stania M, Słomka KJ, Gorzkowska A, Juras G, Okun MS, Christou EA. Detection of postural control in early Parkinson's disease: Clinical testing vs. modulation of center of pressure. PLoS One 2021; 16:e0245353. [PMID: 33434235 PMCID: PMC7802937 DOI: 10.1371/journal.pone.0245353] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/28/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Little is known about the early stage balance changes in PD. Many clinicians assume that there are no postural issues in early PD because of failure to identify them on bedside and clinical testing. Here, we quantify balance changes in early and moderate stage PD and compared these values to healthy controls (HC) using clinical assessments of balance and posturography. METHODS We compared 15 HC with 15 early PD (PD-II; Hoehn and Yahr stage II) and 15 moderate PD (PD-III; H&Y stage III). Participants performed various clinical tests of balance and a standing postural task on a force platform. We quantified the spatiotemporal parameters of the center of pressure (COP), the sample entropy and power spectral density (PSD) of the COP. RESULTS The PSD of the COP differentiated PD-II from HC from 0-0.5 Hz and PD-II from PD-III from 0.5-1 Hz. Specifically, PD-II and PD-III manifested greater power than HC from 0-0.5 Hz, whereas PD-III exhibited greater power than PD-II and HC from 0.5-1.0 Hz (p<0.05). However, there were no significant differences between PD-II and HC in all clinical tests and in spatiotemporal parameters of the COP (p>0.05). Although the sample entropy was significantly lower in the PD groups (p<0.05), entropy failed to differentiate PD-II from PD-III. CONCLUSION The low-frequency modulation of the COP in this small cohort differentiated early PD from HC and from moderate PD. Clinicians should be aware that there are early balance deficits in PD. A larger sample size is needed to confirm these findings.
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Affiliation(s)
- Anna Kamieniarz
- Institute of Sport Sciences, Academy of Physical Education, Katowice, Poland
| | - Justyna Michalska
- Institute of Sport Sciences, Academy of Physical Education, Katowice, Poland
| | - Wojciech Marszałek
- Institute of Sport Sciences, Academy of Physical Education, Katowice, Poland
| | - Magdalena Stania
- Institute of Sport Sciences, Academy of Physical Education, Katowice, Poland
| | - Kajetan J. Słomka
- Institute of Sport Sciences, Academy of Physical Education, Katowice, Poland
| | - Agnieszka Gorzkowska
- Department of Neurorehabilitation, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Grzegorz Juras
- Institute of Sport Sciences, Academy of Physical Education, Katowice, Poland
| | - Michael S. Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States of America
| | - Evangelos A. Christou
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States of America
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States of America
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Postural instability in Parkinson’s disease: Review and bottom-up rehabilitative approaches. Neurophysiol Clin 2020; 50:479-487. [DOI: 10.1016/j.neucli.2020.10.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/07/2020] [Accepted: 10/23/2020] [Indexed: 11/23/2022] Open
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Rodríguez-Rubio PR, Bagur-Calafat C, López-de-Celis C, Bueno-Gracía E, Cabanas-Valdés R, Herrera-Pedroviejo E, Girabent-Farrés M. Validity and Reliability of the Satel 40 Hz Stabilometric Force Platform for Measuring Quiet Stance and Dynamic Standing Balance in Healthy Subjects. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217733. [PMID: 33105835 PMCID: PMC7660083 DOI: 10.3390/ijerph17217733] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/18/2020] [Accepted: 10/20/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND A force platform must have validity and reliability for optimal use. The objective of this study was to analyze the validity and the reliability of the Satel 40 Hz stabilometric force platform. METHODS A study of instrumental validity and reliability, involving a cross-sectional correlational and comparative analysis was performed. To determine the validity, four certified weights located on three axes were used and the ability of the stabilometric force platform to detect changes in the position of the different axes was observed. A test-retest was performed to analyze the reliability. Forty-two symptom-free volunteers participated in the study. Assessments were taken in a standing static position and in a dynamic position, with the eyes open and closed. Three measurements were taken and the intra-class correlation coefficient (ICC) was calculated. RESULTS The validity increased as the weight increased for all the variables measured in the stabilometric parameters (p < 0.05). The reliability was shown to be good to excellent for the two visual conditions. The positional variables obtained a higher ICC. The variable with the best ICC was the Y mean in OE (ICC 0.874 and a p < 0.001). All the values showed an increase in a dynamic situation. CONCLUSION The findings support the reliability and validity of the Satel 40 Hz stabilometric force platform. The platform could be recommended to evaluate static and dynamic standing balance in healthy adult individuals. Guidelines for treatment and the level of quality of stabilometry could be obtained from its use.
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Affiliation(s)
- Pere Ramón Rodríguez-Rubio
- Department of Physiotherapy, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, UIC Barcelona, Sant Cugat del Vallès, 08195 Barcelona, Spain; (P.R.R.-R.); (C.B.-C.); (C.L.-d.-C.); (E.H.-P.)
| | - Caritat Bagur-Calafat
- Department of Physiotherapy, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, UIC Barcelona, Sant Cugat del Vallès, 08195 Barcelona, Spain; (P.R.R.-R.); (C.B.-C.); (C.L.-d.-C.); (E.H.-P.)
| | - Carlos López-de-Celis
- Department of Physiotherapy, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, UIC Barcelona, Sant Cugat del Vallès, 08195 Barcelona, Spain; (P.R.R.-R.); (C.B.-C.); (C.L.-d.-C.); (E.H.-P.)
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
| | - Elena Bueno-Gracía
- Department of Physiatrist and Nursery, Faculty of Heath Sciences, University of Zaragoza, 50009 Zaragoza, Spain;
| | - Rosa Cabanas-Valdés
- Department of Physiotherapy, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, UIC Barcelona, Sant Cugat del Vallès, 08195 Barcelona, Spain; (P.R.R.-R.); (C.B.-C.); (C.L.-d.-C.); (E.H.-P.)
- Correspondence:
| | - Ernesto Herrera-Pedroviejo
- Department of Physiotherapy, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, UIC Barcelona, Sant Cugat del Vallès, 08195 Barcelona, Spain; (P.R.R.-R.); (C.B.-C.); (C.L.-d.-C.); (E.H.-P.)
- Department of Physiotherapy, Blanquerna School of Health Sciences, Ramon Llull University, 08025 Barcelona, Spain
| | - Montserrat Girabent-Farrés
- Department of Physiotherapy, School of health Sciencies, Tecnocampus-pompeu Fabra University, Mataró, 08302 Barcelona, Spain;
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Kamieniarz A, Milert A, Grzybowska-Ganszczyk D, Opara J, Juras G. Tai Chi and Qi Gong therapies as a complementary treatment in Parkinson's disease - a systematic review. Complement Ther Med 2020; 56:102589. [PMID: 33197664 DOI: 10.1016/j.ctim.2020.102589] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 09/30/2020] [Accepted: 09/30/2020] [Indexed: 12/11/2022] Open
Affiliation(s)
- Anna Kamieniarz
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland.
| | - Agata Milert
- Dept. Physiotherapy, Academy of Physical Education, Kraków, Poland
| | | | - Józef Opara
- Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Grzegorz Juras
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
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Delafontaine A, Hansen C, Marolleau I, Kratzenstein S, Gouelle A. Effect of a Concurrent Cognitive Task, with Stabilizing Visual Information and Withdrawal, on Body Sway Adaptation of Parkinsonian's Patients in an Off-Medication State: A Controlled Study. SENSORS (BASEL, SWITZERLAND) 2020; 20:E5059. [PMID: 32899926 PMCID: PMC7571225 DOI: 10.3390/s20185059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/02/2020] [Accepted: 09/04/2020] [Indexed: 12/23/2022]
Abstract
Background: In persons with Parkinson's disease (pwPD) any additional somatosensory or distractor interference can influence the posture. When deprivation of vision and dual-task are associated, the effect on biomechanical performance is less consistent. The aim of this study was to evaluate the role of the visual deprivation and a cognitive task on the static balance in earlier stage PD subjects. Methods: Fifteen off-medication state pwPD (9 women and 6 men), 67.7 ± 7.3 years old, diagnosed PD since 5.4 ± 3.4 years, only Hoehn and Yahr state 2 and fifteen young control adults (7 women and 8 men) aged 24.9 ± 4.9 years, performed semi-tandem task under four randomized experimental conditions: eyes opened single-task, eyes closed single-task, eyes opened dual-task and eyes closed dual-task. The center of pressure (COP) was measured using a force plate and electromyography signals (EMG) of the ankle/hip muscles were recorded. Traditional parameters, including COP pathway length, ellipse area, mediolateral/anteroposterior root-mean-square and non-linear measurements were computed. The effect of vision privation, cognitive task, and vision X cognitive was investigated by a 2 (eyes opened/eyes closed) × 2 (postural task alone/with cognitive task) repeated-measures ANOVA after application of a Bonferroni pairwise correction for multiple comparisons. Significant interactions were further analyzed using post-hoc tests. Results: In pwPD, both COP pathway length (p < 0.01), ellipse area (p < 0.01) and mediolateral/anteroposterior root-mean-square (p < 0.01) were increased with the eyes closed, while the dual-task had no significant effect when compared to the single-task condition. Comparable results were observed in the control group for who COP pathway was longer in all conditions compared to eyes opened single-task (p < 0.01) and longer in conditions with eyes closed compared to eyes opened dual-task (p < 0.01). Similarly, all differences in EMG activity of pwPD were exclusively observed between eyes opened vs. eyes closed conditions, and especially for the forward leg's soleus (p < 0.01) and backward tibialis anterior (p < 0.01). Conclusions: These results in pwPD without noticeable impairment of static balance encourage the assessment of both visual occlusion and dual-task conditions when the appearance of significant alteration during the dual-task could reveal the subtle worsening onset of the balance control.
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Affiliation(s)
- Arnaud Delafontaine
- CIAMS, University Paris-Sud, Université Paris-Saclay, 91405 Orsay, France;
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | - Clint Hansen
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-Universität zu Kiel, 24098 Kiel, Germany;
| | - Iris Marolleau
- CIAMS, University Paris-Sud, Université Paris-Saclay, 91405 Orsay, France;
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | - Stefan Kratzenstein
- CAU Motion Lab, Kiel University, Olshausenstraße 74, 24098 Kiel, Germany;
- Institute of Sport Science, Kiel University, Olshausenstraße 74, 24098 Kiel, Germany
| | - Arnaud Gouelle
- ProtoKinetics, Havertown, PA 19083, USA;
- Laboratory Performance, Santé, Métrologie, Société (PSMS), UFR STAPS, 51100 Reims, France
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Kudrevatykh A, Senkevich K, Miliukhina I. Postural instability and neuropsychiatric disturbance in the overlapping phenotype of essential tremor and Parkinson's Disease. Neurophysiol Clin 2020; 50:489-494. [PMID: 32873435 DOI: 10.1016/j.neucli.2020.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 07/15/2020] [Accepted: 07/15/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES The aim of this study was to perform a comparative analysis of postural and neuropsychiatric features in patients with essential tremor (ET), various Parkinson's disease (PD) phenotypes, and the phenotype of combined ET and PD (ET-PD). METHODS 169 PD patients with early (1.0-2.0) and 111 PD patients with advanced (2.5-3.0) stages based on the Hoehn and Yahr scale, 55 patients with ET and 26 patients with ET-PD were enrolled in the study. Motor and non-motor symptoms of patients with PD, ET and ET-PD were studied using standardized scales and stabilometry. RESULTS Patients with ETPD had milder manifestations of parkinsonism compared to PD patients at the same stages of the disease. Patients in the advanced PD group showed more pronounced posture and balance impairment compared to all other groups assessed by standardized walking and balance scales. No difference using scales for postural assessment was found between ETPD, ET and early stage PD. Using stabilometry, we discovered that indexes of stabilometric parameters were lower in ETPD patients compared to ET and advanced PD, although no difference between ETPD and early PD was found. PD patients in early stages had lower results in most of the indexes compared to ET. CONCLUSION Here, we conducted for the first time a stabilometric examination of ET-PD patients, which could be helpful in differential diagnosis. This analysis helps expand understanding of the clinical manifestations of PD, ET and ET-PD.
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Affiliation(s)
- Anastasia Kudrevatykh
- Institute of Experimental Medicine, St. Petersburg, Russia; First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russia
| | - Konstantin Senkevich
- First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russia; Petersburg Nuclear Physics Institute Named by B.P. Konstantinov of National Research Centre "Kurchatov Institute", Gatchina, Russia.
| | - Irina Miliukhina
- Institute of Experimental Medicine, St. Petersburg, Russia; First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russia; Petersburg Nuclear Physics Institute Named by B.P. Konstantinov of National Research Centre "Kurchatov Institute", Gatchina, Russia
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Michalska J, Kamieniarz A, Brachman A, Marszałek W, Cholewa J, Juras G, Słomka KJ. Fall-related measures in elderly individuals and Parkinson's disease subjects. PLoS One 2020; 15:e0236886. [PMID: 32790749 PMCID: PMC7425912 DOI: 10.1371/journal.pone.0236886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 07/15/2020] [Indexed: 11/18/2022] Open
Abstract
Falls pose a serious problem in elderly and clinical populations. Most often, they lead to a loss of mobility and independence. They might also be an indirect cause of death. The aim of this study was to determine an objective predictor of the fear of falling and falls in elderly subjects (ESs) and Parkinson's disease (PD) subjects. Thirty-two ESs were examined in this study, of whom sixteen were diagnosed with PD. The testing procedures comprised force plate measurements (limit of stability test-LOS test) and clinical tests (Berg Balance Scale, Functional Reach Test, Timed Up and Go test, Tinetti test). The Falls Efficacy Scale International (FES-I) was used to evaluate the fear of falling. The range of the maximum forward lean was normalized to the length from the ankle joint to the head of the first metatarsal bone and was named the functional forward stability indicator (FFSI). The FFSI, derived from the LOS test, allowed us to demonstrate the real deficit in functional stability and individual safety margins. Moreover, the FFSI was highly correlated with the FES-I score and almost all clinical test results in elderly subjects (r>0,6; p<0.05). In PD subjects, the FFSI was poorly correlated with the fear of falling, the BBS score and the FR distance; however, a high correlation with the Tinetii test (r>0,6, p<0.05) was noted. The PD subjects presented a different balance strategy when close to their stability limits, which was also reflected in the lower values of sample entropy (t = (-2.40); p<0.05; d = 0.87). The FFSI might be a good predictor of the fear of falling in the group of elderly people. Additionally, the FFSI allows us to show real balance deficits both in PD subjects and in their healthy peers without the need for a reference group and norms. In conclusion, it is postulated that the popular clinical assessments of postural balance in PD subjects should be accompanied by reliable posturography measurements.
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Affiliation(s)
- Justyna Michalska
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
- * E-mail:
| | - Anna Kamieniarz
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Anna Brachman
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Wojciech Marszałek
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Joanna Cholewa
- Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Grzegorz Juras
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Kajetan J. Słomka
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
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29
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Liu XH, Li Y, Xu HL, Sikandar A, Lin WH, Li GH, Li XF, Alimu A, Yu SB, Ye XH, Wang N, Ni J, Chen WJ, Gan SR. Quantitative assessment of postural instability in spinocerebellar ataxia type 3 patients. Ann Clin Transl Neurol 2020; 7:1360-1370. [PMID: 32638517 PMCID: PMC7448197 DOI: 10.1002/acn3.51124] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/05/2020] [Accepted: 06/15/2020] [Indexed: 12/17/2022] Open
Abstract
Objective Spinocerebellar ataxia type 3 (SCA3) is one of the most common hereditary neurodegenerative diseases, with balance instability as main symptom. Balance quantification is crucial for evaluating the efficacy of therapeutic interventions. However, balance evaluation in SCA3 is often subject to bias. Here, we aimed to quantitatively evaluate postural instability and investigate the relationship between postural instability and clinical characteristics in SCA3 patients. Methods Sixty‐two SCA3 patients and 62 normal controls were recruited, and their postural balance was measured using a posturographic platform. Principal component analysis was performed as data reduction to identify postural instability factors. Multivariable linear regression was used to investigate potential risk factors for postural instability and to explore whether postural instability predicts the severity and progression of ataxia in SCA3 patients. Results We found SCA3 patients experience postural instability characterized by significant impairment in static and dynamic stability. The condition without visual feedback was the most sensitive measure in differentiating SCA3 from controls. Regression analyses revealed that ataxia severity predicted both static (P = 0.014) and dynamic stability (P = 0.001). Likewise, along with expanded CAG repeats (P < 0.001), both static (P < 0.001) and dynamic stability (P < 0.001) predicted ataxia severity, but not ataxia progression. Interpretation Our findings demonstrate the validity of using the Pro‐kin system for assessing postural instability in SCA3 patients. This type of quantitative assessment of balance dysfunction can contribute to clinical trials and balance rehabilitation in SCA3 patients.
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Affiliation(s)
- Xia-Hua Liu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Ying Li
- Fujian Medical University, Fuzhou, China
| | - Hao-Ling Xu
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Arif Sikandar
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Wei-Hong Lin
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Gui-He Li
- Fujian Medical University, Fuzhou, China
| | | | | | | | | | - Ning Wang
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
| | - Jun Ni
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Wan-Jin Chen
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
| | - Shi-Rui Gan
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
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30
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Hébert-Losier K, Murray L. Reliability of centre of pressure, plantar pressure, and plantar-flexion isometric strength measures: A systematic review. Gait Posture 2020; 75:46-62. [PMID: 31593873 DOI: 10.1016/j.gaitpost.2019.09.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 09/20/2019] [Accepted: 09/24/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Centre of pressure (COP), plantar pressure (PP), and plantar-flexion isometric strength (PFisom) are often examined in relation to postural control and gait. RESEARCH QUESTION Our aim was to systematically review and quality appraise articles addressing the reliability of COP and PP measures in static stance and PFisom measures. METHODS Three electronic databases (SCOPUS®, SportDISCUS™, and PubMed) were searched and supplemented by a manual search. Peer-reviewed original research on the reliability of COP, PP, and PFisom in healthy adults (≥18 years) was included. Quality appraisal was done according to the updated COnsensus-based Standards for the selection of health Measurement INstruments reliability checklist. Data regarding study characteristics, test protocols, outcome measures, and reliability metrics were extracted. RESULTS Forty articles met inclusion and were assessed for their methodological quality. Only four articles (10%) obtained uppermost quality scores. From the reviewed studies, the most reliable measures were: COP sway area and path length; PP mean pressure, percentage body weight distribution, and contact area; and PFisom peak torque and force. Although these measures generally exhibited good-to-excellent relative reliability based on correlation coefficients, absolute reliability based on typical errors were not always optimal (variation > 10%). Literature on PP reliability was scarce (n = 2). SIGNIFICANCE Our findings highlight the need for better quality methodological reliability studies to be undertaken to make stronger inferences about the reliability of COP, PP, and PFisom measures. The most reliable measures based on the current review are: COP sway area and path length; PP mean pressure, percentage of body weight distribution, and contact area; and PFisom peak torque and peak force. These measures are the ones that should be selected preferentially in clinical settings, bearing in mind that their typical errors might be suboptimal despite exhibiting strong relative reliability.
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Affiliation(s)
- Kim Hébert-Losier
- University of Waikato, Division of Health, Engineering, Computing and Science, School of Health, Adams Centre for High Performance, 52 Miro Street, Mount Maunganui, 3116, Tauranga, New Zealand.
| | - Lauralee Murray
- University of Waikato, Division of Health, Engineering, Computing and Science, School of Health, Adams Centre for High Performance, 52 Miro Street, Mount Maunganui, 3116, Tauranga, New Zealand.
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Halmi Z, Dinya E, Málly J. Destroyed non-dopaminergic pathways in the early stage of Parkinson's disease assessed by posturography. Brain Res Bull 2019; 152:45-51. [PMID: 31295517 DOI: 10.1016/j.brainresbull.2019.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 06/29/2019] [Accepted: 07/02/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND The early stage of Parkinson's disease (PD) (Hoehn-Yahr (HY) I-II stages) is characterized by a negative pull test, which clinically excludes postural instability. Previous studies with dynamic posturography detected balance disturbances even at the onset of the disease but the age dependency or prediction of dyskinesia with dynamic posturography are not known. OBJECTIVE/HYPOTHESIS We hypothesized that the postural instability evoked by dynamic posturography was part of the early stage of PD. Furthermore, we studied how we can provoke dyskinesia. METHODS Postural instability with static and dynamic posturography (passing balls with different weights around the body) was studied in 45 patients with PD in their HY I, II stages. They were compared with 35 age-matched healthy controls. Eighteen patients with dyskinesia were involved in the study. Fourteen patients were followed for two years. RESULTS The pathway and velocity of the movement assessed by static and the dynamic posturography were significantly higher in the group >65 years than that of age-matched healthy controls, while the group ≤65 years showed a significant increment only in the antero-posterior sway during dynamic posturography. The imbalance of patients with dyskinesia was significantly (p < 0.05) provoked by dynamic posturography compared to patients with PD without dyskinesia. The results were independent of age. CONCLUSION Postural instability is part of the early symptoms of PD. Non-dopaminergic pathways may be involved in the early stage of PD.
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Affiliation(s)
- Zsófia Halmi
- Dept. Developmental Neurology, Saint Margaret Hospital, Budapest, Hungary
| | - Elek Dinya
- Semmelweis Univ. Digital Health Dept., Budapest, Hungary
| | - Judit Málly
- Inst. of Neurorehabilitation, Sopron, Hungary.
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