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Ohara M, Hirata K, Matsubayashi T, Chen Q, Shimano K, Hanazawa R, Hirakawa A, Yokota T, Hattori T. Circular walking is useful for assessing the risk of falls in early progressive supranuclear palsy. J Neurol 2024; 271:6349-6358. [PMID: 39009736 DOI: 10.1007/s00415-024-12551-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 06/26/2024] [Accepted: 06/27/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Progressive supranuclear palsy (PSP) is characterized by early onset postural instability and frequent falls. Circular walking necessitates dynamic postural control, which is impaired in patients with PSP. We aimed to explore gait parameters associated with the risk of falls in patients with PSP, focusing on circular walking. METHODS Sixteen drug-naïve patients with PSP, 22 drug-naïve patients with Parkinson's disease (PD), and 23 healthy controls were enrolled. Stride lengths/velocities and their coefficients of variation (CV) during straight and circular walking (walking around a circle of 1-m diameter) were measured under single-task and cognitive dual-task conditions. Correlation analysis was performed between gait parameters and postural instability and gait difficulty (PIGD) motor subscores, representing the risk of falls. RESULTS Patients with PSP had significantly higher CVs of stride lengths/velocities during circular walking than those during straight walking, and the extent of exacerbation of CVs in patients with PSP was larger than that in patients with PD under single-task conditions. Stride lengths/velocities and their CVs were significantly correlated with PIGD motor subscores in patients with PSP only during single-task circular walking. In addition, patients with PSP showed progressive decrements of stride lengths/velocities over steps only during single-task circular walking. CONCLUSIONS Worse gait parameters during circular walking are associated with an increased risk of falls in patients with PSP. Circular walking is a challenging task to demand the compromised motor functions of patients with PSP, unmasking impaired postural control and manifesting sequence effect. Assessing circular walking is useful for evaluating the risk of falls in patients with early PSP.
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Affiliation(s)
- Masahiro Ohara
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Kosei Hirata
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Taiki Matsubayashi
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Qingmeng Chen
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Kaoru Shimano
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Ryoichi Hanazawa
- Department of Clinical Biostatistics, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Akihiro Hirakawa
- Department of Clinical Biostatistics, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takanori Yokota
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Takaaki Hattori
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
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van Midden V, Simončič U, Pirtošek Z, Kojović M. The Effect of taVNS at 25 Hz and 100 Hz on Parkinson's Disease Gait-A Randomized Motion Sensor Study. Mov Disord 2024; 39:1375-1385. [PMID: 38757756 DOI: 10.1002/mds.29826] [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: 01/15/2024] [Revised: 03/27/2024] [Accepted: 04/15/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Transcutaneous electrostimulation of the auricular branch of the vagal nerve (taVNS) has the propensity to reach diffuse neuromodulatory networks, which are dysfunctional in Parkinson's disease (PD). Previous studies support the use of taVNS as an add-on treatment for gait in PD. OBJECTIVES We assessed the effect of taVNS at 25 Hz (taVNS25), taVNS at 100 Hz (taVNS100), and sham earlobe stimulation (sVNS) on levodopa responsive (arm swing velocity, arm range of motion, stride length, gait speed) and non-responsive gait characteristics (arm range of motion asymmetry, anticipatory postural adjustment [APA] duration, APA first step duration, APA first step range of motion), and turns (first turn duration, double 360° turn duration, steps per turn) in advanced PD. METHODS In our double blind sham controlled within-subject randomized trial, we included 30 PD patients (modified Hoehn and Yahr stage, 2.5-4) to assess the effect of taVNS25, taVNS100, and sVNS on gait characteristics measured with inertial motion sensors during the instrumented stand and walk test and a double 360° turn. Separate generalized mixed models were built for each gait characteristic. RESULTS During taVNS100 compared to sVNS arm swing velocity (P = 0.030) and stride length increased (P = 0.027), and APA duration decreased (P = 0.050). During taVNS25 compared to sVNS stride length (P = 0.024) and gait speed (P = 0.021) increased and double 360° turn duration decreased (P = 0.039). CONCLUSIONS We have found that taVNS has a frequency specific propensity to improve stride length, arm swing velocity, and gait speed and double 360° turn duration in PD patients. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Vesna van Midden
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Urban Simončič
- Faculty of Mathematics and Physics, University of Ljubljana, Ljubljana, Slovenia
- Jozef Stefan Institute, Ljubljana, Slovenia
| | - Zvezdan Pirtošek
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Maja Kojović
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
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Mao Q, Zheng W, Shi M, Yang F. Scientometric Research and Critical Analysis of Gait and Balance in Older Adults. SENSORS (BASEL, SWITZERLAND) 2024; 24:3199. [PMID: 38794055 PMCID: PMC11125350 DOI: 10.3390/s24103199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024]
Abstract
Gait and balance have emerged as a critical area of research in health technology. Gait and balance studies have been affected by the researchers' slow follow-up of research advances due to the absence of visual inspection of the study literature across decades. This study uses advanced search methods to analyse the literature on gait and balance in older adults from 1993 to 2022 in the Web of Science (WoS) database to gain a better understanding of the current status and trends in the field for the first time. The study analysed 4484 academic publications including journal articles and conference proceedings on gait and balance in older adults. Bibliometric analysis methods were applied to examine the publication year, number of publications, discipline distribution, journal distribution, research institutions, application fields, test methods, analysis theories, and influencing factors in the field of gait and balance. The results indicate that the publication of relevant research documents has been steadily increasing from 1993 to 2022. The United States (US) exhibits the highest number of publications with 1742 articles. The keyword "elderly person" exhibits a strong citation burst strength of 18.04, indicating a significant focus on research related to the health of older adults. With a burst factor of 20.46, Harvard University has made impressive strides in the subject. The University of Pittsburgh displayed high research skills in the area of gait and balance with a burst factor of 7.7 and a publication count of 103. The research on gait and balance mainly focuses on physical performance evaluation approaches, and the primary study methods include experimental investigations, computational modelling, and observational studies. The field of gait and balance research is increasingly intertwined with computer science and artificial intelligence (AI), paving the way for intelligent monitoring of gait and balance in the elderly. Moving forward, the future of gait and balance research is anticipated to highlight the importance of multidisciplinary collaboration, intelligence-driven approaches, and advanced visualization techniques.
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Affiliation(s)
- Qian Mao
- School of Design, The Hong Kong Polytechnic University, Hong Kong
| | - Wei Zheng
- Department of Computer Science and Technology, Tsinghua University, Beijing 100190, China
| | - Menghan Shi
- Lancaster Imagination Lab, Lancashire, Lancaster LA1 4YD, UK
| | - Fan Yang
- Electrical and Electronic Engineering Department, The Hong Kong Polytechnic University, Hong Kong
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Langer A, Hansen C, Roth D, Santer A, Flotz A, Gruber J, Wizany L, Hasenauer S, Pokan R, Dabnichki P, Treven M, Zimmel S, Schmoeger M, Willinger U, Gassner L, Brücke C, Maetzler W, Zach H. Vertical locomotion improves horizontal locomotion: effects of climbing on gait and other mobility aspects in Parkinson's disease. A secondary analysis from a randomized controlled trial. J Neuroeng Rehabil 2024; 21:63. [PMID: 38678241 PMCID: PMC11055236 DOI: 10.1186/s12984-024-01363-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 04/22/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND In the Climb Up! Head Up! trial, we showed that sport climbing reduces bradykinesia, tremor, and rigidity in mildly to moderately affected participants with Parkinson's disease. This secondary analysis aimed to evaluate the effects of sport climbing on gait and functional mobility in this cohort. METHODS Climb Up! Head Up! was a 1:1 randomized controlled trial. Forty-eight PD participants (Hoehn and Yahr stage 2-3) either participated in a 12-week, 90-min-per-week sport climbing course (intervention group) or were engaged in regular unsupervised physical activity (control group). Relevant outcome measures for this analysis were extracted from six inertial measurement units placed on the extremities, chest, and lower back, that were worn during supervised gait and functional mobility assessments before and after the intervention. Assessments included normal and fast walking, dual-tasking walking, Timed Up and Go test, Instrumented Stand and Walk test, and Five Times Sit to Stand test. RESULTS Compared to baseline, climbing improved gait speed during normal walking by 0.09 m/s (p = 0.005) and during fast walking by 0.1 m/s. Climbing also reduced the time spent in the stance phase during fast walking by 0.03 s. Climbing improved the walking speed in the 7-m- Timed Up and Go test by 0.1 m/s (p < 0.001) and the turning speed by 0.39 s (p = 0.052), the speed in the Instrumented Stand and Walk test by 0.1 m/s (p < 0.001), and the speed in the Five Times Sit to Stand test by 2.5 s (p = 0.014). There was no effect of sport climbing on gait speed or gait variables during dual-task walking. CONCLUSIONS Sport climbing improves gait speed during normal and fast walking, as well as functional mobility in people with Parkinson's disease. Trial registration This study was registered within the U.S. National Library of Medicine (No: NCT04569981, date of registration September 30th, 2020).
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Affiliation(s)
- Agnes Langer
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Clint Hansen
- Department of Neurology, University Hospital Schleswig-Holstein and Kiel University, 24105, Kiel, Germany
| | - Dominik Roth
- Department of Emergency Medicine, Medical University of Vienna, 1090, Vienna, Austria
| | - Agnes Santer
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Anna Flotz
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Jakob Gruber
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Laurenz Wizany
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Sebastian Hasenauer
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Rochus Pokan
- Department of Sport Physiology, Institute of Sports Sciences, University of Vienna, 1090, Vienna, Austria
| | - Peter Dabnichki
- School of Engineering, RMIT University, 3000, Melbourne, VIC, Australia
| | - Marco Treven
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Sarah Zimmel
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Michaela Schmoeger
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Ulrike Willinger
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Lucia Gassner
- Department of Sport Physiology, Institute of Sports Sciences, University of Vienna, 1090, Vienna, Austria
- School of Engineering, RMIT University, 3000, Melbourne, VIC, Australia
| | - Christof Brücke
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Walter Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein and Kiel University, 24105, Kiel, Germany
| | - Heidemarie Zach
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria.
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Timm EC, Purcell NL, Ouyang B, Berry-Kravis E, Hall DA, O’Keefe JA. Potential Prodromal Digital Postural Sway Markers for Fragile X-Associated Tremor/Ataxia Syndrome (FXTAS) Detected via Dual-Tasking and Sensory Manipulation. SENSORS (BASEL, SWITZERLAND) 2024; 24:2586. [PMID: 38676203 PMCID: PMC11054629 DOI: 10.3390/s24082586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 03/27/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024]
Abstract
FXTAS is a neurodegenerative disorder occurring in some Fragile X Messenger Ribonucleoprotein 1 (FMR1) gene premutation carriers (PMCs) and is characterized by cerebellar ataxia, tremor, and cognitive deficits that negatively impact balance and gait and increase fall risk. Dual-tasking (DT) cognitive-motor paradigms and challenging balance conditions may have the capacity to reveal markers of FXTAS onset. Our objectives were to determine the impact of dual-tasking and sensory and stance manipulation on balance in FXTAS and potentially detect subtle postural sway deficits in FMR1 PMCs who are asymptomatic for signs of FXTAS on clinical exam. Participants with FXTAS, PMCs without FXTAS, and controls underwent balance testing using an inertial sensor system. Stance, vision, surface stability, and cognitive demand were manipulated in 30 s trials. FXTAS participants had significantly greater total sway area, jerk, and RMS sway than controls under almost all balance conditions but were most impaired in those requiring vestibular control. PMCs without FXTAS had significantly greater RMS sway compared with controls in the feet apart, firm, single task conditions both with eyes open and closed (EC) and the feet together, firm, EC, DT condition. Postural sway deficits in the RMS postural sway variability domain in asymptomatic PMCs might represent prodromal signs of FXTAS. This information may be useful in providing sensitive biomarkers of FXTAS onset and as quantitative balance measures in future interventional trials and longitudinal natural history studies.
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Affiliation(s)
- Emily C. Timm
- Department of Anatomy & Cell Biology, Rush University Medical Center, Chicago, IL 60612, USA; (E.C.T.); (E.B.-K.)
| | - Nicollette L. Purcell
- Department of Anatomy & Cell Biology, Rush University Medical Center, Chicago, IL 60612, USA; (E.C.T.); (E.B.-K.)
| | - Bichun Ouyang
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA; (B.O.); (D.A.H.)
| | - Elizabeth Berry-Kravis
- Department of Anatomy & Cell Biology, Rush University Medical Center, Chicago, IL 60612, USA; (E.C.T.); (E.B.-K.)
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA; (B.O.); (D.A.H.)
- Department of Pediatrics, Rush University Medical Center, Chicago, IL 60612, USA
| | - Deborah A. Hall
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA; (B.O.); (D.A.H.)
| | - Joan Ann O’Keefe
- Department of Anatomy & Cell Biology, Rush University Medical Center, Chicago, IL 60612, USA; (E.C.T.); (E.B.-K.)
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA; (B.O.); (D.A.H.)
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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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Lewis MM, Waltz C, Scelina L, Scelina K, Owen KM, Hastilow K, Zimmerman EM, Rosenfeldt AB, Miller Koop M, Alberts JL. Gait patterns during overground and virtual omnidirectional treadmill walking. J Neuroeng Rehabil 2024; 21:29. [PMID: 38388883 PMCID: PMC10885397 DOI: 10.1186/s12984-023-01286-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 11/20/2023] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Omnidirectional treadmills (ODTs) offer a promising solution to the virtual reality (VR) locomotion problem, which describes the mismatch between visual and somatosensory information and contributes to VR sickness. However, little is known about how walking on ODTs impacts the biomechanics of gait. This project aimed to compare overground and ODT walking and turning in healthy young adults. METHODS Fifteen young adults completed forward walk, 180° turn, and 360° turn tasks under three conditions: (1) overground, (2) on the Infinadeck ODT in a virtual environment without a handrail, and (3) on the ODT with a handrail. Kinematic data for all walking trials were gathered using 3D optical motion capture. RESULTS Overall, gait speed was slower during ODT walking than overground. When controlling for gait speed, ODT walking resulted in shorter steps and greater variability in step length. There were no significant differences in other spatiotemporal metrics between ODT and overground walking. Turning on the ODT required more steps and slower rotational speeds than overground turns. The addition of the stability handrail to the ODT resulted in decreased gait variability relative to the ODT gait without the handrail. CONCLUSION Walking on an ODT resembles natural gait patterns apart from slower gait speed and shorter step length. Slower walking and shorter step length are likely due to the novelty of physically navigating a virtual environment which may result in a more conservative approach to gait. Future work will evaluate how older adults and those with neurological disease respond to ODT walking.
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Affiliation(s)
- Morgan McGrath Lewis
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA.
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
| | - Colin Waltz
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Logan Scelina
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Kathryn Scelina
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Kelsey M Owen
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Karissa Hastilow
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Eric M Zimmerman
- Neurological Institute, Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA
| | - Anson B Rosenfeldt
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Mandy Miller Koop
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Jay L Alberts
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA.
- Neurological Institute, Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA.
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Clarkin CM, Ward-Ritacco CL, Mahler L. Exercise-Induced Functional Changes in People with Parkinson's Disease following External Cueing and Task-Based Intervention. Rehabil Res Pract 2024; 2024:6188546. [PMID: 38283384 PMCID: PMC10817815 DOI: 10.1155/2024/6188546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 08/09/2023] [Accepted: 12/23/2023] [Indexed: 01/30/2024] Open
Abstract
Introduction The purpose of this study was to evaluate change in motor function, gait speed, dynamic balance, balance confidence, and quality of life (QoL) in nine participants with Parkinson's disease (PwPD) completing Lee Silverman Voice Treatment BIG (LSVT-BIG), an external cueing and task-based intervention. Although supported as an efficacious treatment in PwPD, there is limited research examining clinically meaningful change in outcome measures related to external cueing and task-based interventions. Materials and Methods This was a case series of nine PwPD (age range 64-76 years, 55% male) who completed the LSVT-BIG protocol. Disease duration ranged from 1 to 17 years and was classified as moderate in all participants (Hoehn and Yahr = 2 or 3). Outcome measures included motor function (MDS-UPDRS Part III Motor), gait speed, dynamic balance (MiniBEST), Activities-specific Balance Confidence (ABC), and Summary Index for PD Quality of Life 39 (PDQ-SI). Assessments were completed at baseline (BASE), end of treatment (EOT), and 4 weeks after EOT (EOT+4). Results Minimal detectable change (MDC) or minimal clinical important difference (MCID) was observed in one or more outcome measures in 8 of 9 participants at EOT and EOT+4 across domains of motor function (67%, 78%), gait speed (78%, 67%), balance confidence (44%, 33%), quality of life (44%, 78%), and dynamic balance (22%, 22%). Discussion. In this case series, 8 of 9 participants showed MDC or MCID changes across multiple functional domains. Improvements were observed immediately post (EOT) and 4-week post-treatment (EOT+4) suggesting a temporal component of the LSVT-BIG impact on functional change. Future research should include clinical trials to examine additional external cueing and task-based intervention efficacy with consideration of intensity, frequency, and mode of delivery across disease severity.
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Affiliation(s)
- Christine M. Clarkin
- Physical Therapy Department, University of Rhode Island, Kingston, Rhode Island, USA
- Interdisciplinary Neuroscience Program, University of Rhode Island, Kingston, Rhode Island, USA
| | - Christie L. Ward-Ritacco
- Interdisciplinary Neuroscience Program, University of Rhode Island, Kingston, Rhode Island, USA
- Department of Kinesiology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Leslie Mahler
- Interdisciplinary Neuroscience Program, University of Rhode Island, Kingston, Rhode Island, USA
- Department of Communicative Disorders, University of Rhode Island, Kingston, Rhode Island, USA
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9
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Hafer JF, Vitali R, Gurchiek R, Curtze C, Shull P, Cain SM. Challenges and advances in the use of wearable sensors for lower extremity biomechanics. J Biomech 2023; 157:111714. [PMID: 37423120 PMCID: PMC10529245 DOI: 10.1016/j.jbiomech.2023.111714] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/23/2023] [Accepted: 07/03/2023] [Indexed: 07/11/2023]
Abstract
The use of wearable sensors for the collection of lower extremity biomechanical data is increasing in popularity, in part due to the ease of collecting data and the ability to capture movement outside of traditional biomechanics laboratories. Consequently, an increasing number of researchers are facing the challenges that come with utilizing the data captured by wearable sensors. These challenges include identifying/calculating meaningful measures from unfamiliar data types (measures of acceleration and angular velocity instead of positions and joint angles), defining sensor-to-segment alignments for calculating traditional biomechanics metrics, using reduced sensor sets and machine learning to predict unmeasured signals, making decisions about when and how to make algorithms freely available, and developing or replicating methods to perform basic processing tasks such as recognizing activities of interest or identifying gait events. In this perspective article, we present our own approaches to common challenges in lower extremity biomechanics research using wearable sensors and share our perspectives on approaching several of these challenges. We present these perspectives with examples that come mostly from gait research, but many of the concepts also apply to other contexts where researchers may use wearable sensors. Our goal is to introduce common challenges to new users of wearable sensors, and to promote dialogue amongst experienced users towards best practices.
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Affiliation(s)
- Jocelyn F Hafer
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States.
| | - Rachel Vitali
- Department of Mechanical Engineering, University of Iowa, Iowa City, IA, United States
| | - Reed Gurchiek
- Department of Bioengineering, Stanford University, Stanford, CA, United States
| | - Carolin Curtze
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, United States
| | - Peter Shull
- State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, China
| | - Stephen M Cain
- Department of Chemical and Biomedical Engineering, West Virginia University, Morgantown, WV, United States
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Wu H, Wu C, Qin J, Zhou C, Tan S, DuanMu X, Guan X, Bai X, Guo T, Wu J, Chen J, Wen J, Cao Z, Gao T, Gu L, Huang P, Zhang B, Xu X, Zhang M. Functional connectome predicting individual gait function and its relationship with molecular architecture in Parkinson's disease. Neurobiol Dis 2023:106216. [PMID: 37385459 DOI: 10.1016/j.nbd.2023.106216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 06/18/2023] [Accepted: 06/26/2023] [Indexed: 07/01/2023] Open
Abstract
Gait impairment is a common symptom of Parkinson's disease (PD), but its neural signature remains unclear due to the interindividual variability of gait performance. Identifying a robust gait-brain correlation at the individual level would provide insight into a generalizable neural basis of gait impairment. In this context, this study aimed to detect connectome that can predict individual gait function of PD, and follow-up analyses assess the molecular architecture underlying the connectome by relating it to the neurotransmitter-receptor/transporter density maps. Resting-state functional magnetic resonance imaging was used to detect the functional connectome, and gait function was assessed via a 10 m-walking test. The functional connectome was first detected within drug-naive patients (N = 48) by using connectome-based predictive modeling following cross-validation and then successfully validated within drug-managed patients (N = 30). The results showed that the motor, subcortical, and visual networks played an important role in predicting gait function. The connectome generated from patients failed to predict the gait function of 33 normal controls (NCs) and had distinct connection patterns compared to NCs. The negative connections (connection negatively correlated with 10 m-walking-time) pattern of the PD connectome was associated with the density of the D2 receptor and VAChT transporter. These findings suggested that gait-associated functional alteration induced by PD pathology differed from that induced by aging degeneration. The brain dysfunction related to gait impairment was more commonly found in regions expressing more dopaminergic and cholinergic neurotransmitters, which may aid in developing targeted treatments.
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Affiliation(s)
- Haoting Wu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Chenqing Wu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Jianmei Qin
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Cheng Zhou
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Sijia Tan
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Xiaojie DuanMu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Xiaojun Guan
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Xueqin Bai
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Tao Guo
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Jingjing Wu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Jingwen Chen
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Jiaqi Wen
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Zhengye Cao
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Ting Gao
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Luyan Gu
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Peiyu Huang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Baorong Zhang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Xiaojun Xu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Minming Zhang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China.
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11
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LeBaron V, Homdee N, Ogunjirin E, Patel N, Blackhall L, Lach J. Describing and visualizing the patient and caregiver experience of cancer pain in the home context using ecological momentary assessments. Digit Health 2023; 9:20552076231194936. [PMID: 37654707 PMCID: PMC10467200 DOI: 10.1177/20552076231194936] [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: 03/31/2023] [Accepted: 07/28/2023] [Indexed: 09/02/2023] Open
Abstract
Background Pain continues to be a difficult and pervasive problem for patients with cancer, and those who care for them. Remote health monitoring systems (RHMS), such as the Behavioral and Environmental Sensing and Intervention for Cancer (BESI-C), can utilize Ecological Momentary Assessments (EMAs) to provide a more holistic understanding of the patient and family experience of cancer pain within the home context. Methods Participants used the BESI-C system for 2-weeks which collected data via EMAs deployed on wearable devices (smartwatches) worn by both patients with cancer and their primary family caregiver. We developed three unique EMA schemas that allowed patients and caregivers to describe patient pain events and perceived impact on quality of life from their own perspective. EMA data were analyzed to provide a descriptive summary of pain events and explore different types of data visualizations. Results Data were collected from five (n = 5) patient-caregiver dyads (total 10 individual participants, 5 patients, 5 caregivers). A total of 283 user-initiated pain event EMAs were recorded (198 by patients; 85 by caregivers) over all 5 deployments with an average severity score of 5.4/10 for patients and 4.6/10 for caregivers' assessments of patient pain. Average self-reported overall distress and pain interference levels (1 = least distress; 4 = most distress) were higher for caregivers (x ¯ 3.02, x ¯ 2.60 , respectively ) compared to patients (x ¯ 2.82, x ¯ 2.25, respectively) while perceived burden of partner distress was higher for patients (i.e., patients perceived caregivers to be more distressed, x ¯ 3.21, than caregivers perceived patients to be distressed, x ¯ 2.55 ). Data visualizations were created using time wheels, bubble charts, box plots and line graphs to graphically represent EMA findings. Conclusion Collecting data via EMAs is a viable RHMS strategy to capture longitudinal cancer pain event data from patients and caregivers that can inform personalized pain management and distress-alleviating interventions.
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Affiliation(s)
- Virginia LeBaron
- University of Virginia School of Nursing, Charlottesville, VA, USA
| | - Nutta Homdee
- Center for Research Innovation and Biomedical Informatics, Faculty of Medical Technology, Mahidol University, Nakhon Pathom, Thailand
| | - Emmanuel Ogunjirin
- University of Virginia School of Engineering & Applied Science, Charlottesville, VA, USA
| | - Nyota Patel
- University of Virginia School of Engineering & Applied Science, Charlottesville, VA, USA
| | - Leslie Blackhall
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - John Lach
- The George Washington University School of Engineering & Applied Science, Washington, DC, USA
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12
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Castro IP, Valença GT, Pinto EB, Cavalcanti HM, Oliveira‐Filho J, Almeida LRS. Predictors of Falls with Injuries in People with Parkinson's Disease. Mov Disord Clin Pract 2022; 10:258-268. [PMID: 36825046 PMCID: PMC9941941 DOI: 10.1002/mdc3.13636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 11/03/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
Background Falls are frequent in Parkinson's disease (PD), but there is lack of information about predictors of injurious falls. Objectives To determine predictors of falls with injuries in people with PD; to compare circumstances and consequences of falls in single and recurrent fallers. Methods Participants (n = 225) were assessed by disease-specific, self-report, and balance measures, and followed-up for 12 months with a diary to record falls, their circumstances, and injuries. Univariate and multivariate analyses were performed. Circumstances and consequences of falls presented by single and recurrent fallers were compared. Results A total of 805 falls were analyzed, 107 (13%) were falls with injuries. Multivariate logistic regression model revealed that greater PD duration and higher balance confidence were protective factors; better balance during gait, outdoor falls, and falls related to extrinsic factors were risk factors for falls with injuries, when compared to falls with no injuries. Multivariate multinomial regression model revealed that, when compared to zero fall, past falls and daily levodopa equivalent dose were predictors of falls with injuries; these predictors together with disability were predictors of falls with no injuries. Single falls (n = 27; 3%) were more common outdoors because of extrinsic factors, whereas recurrent falls (n = 778; 97%) were more common indoors because of intrinsic factors. Single falls led to more injuries than recurrent falls (P < 0.05). Conclusions Different predictors of falls with injuries were obtained when different outcomes were compared. It should be noted that falls with injuries might be influenced by fall-related activities and environmental factors. Single and recurrent falls differed on circumstances and consequences.
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Affiliation(s)
- Isabella P.R. Castro
- Postgraduate Program in Health SciencesFederal University of Bahia School of MedicineSalvadorBahiaBrazil,Motor Behavior and Neurorehabilitation Research GroupBahiana School of Medicine and Public HealthSalvadorBahiaBrazil
| | - Guilherme T. Valença
- Movement Disorders and Parkinson's Disease ClinicRoberto Santos General HospitalSalvadorBahiaBrazil
| | - Elen Beatriz Pinto
- Motor Behavior and Neurorehabilitation Research GroupBahiana School of Medicine and Public HealthSalvadorBahiaBrazil,Department of Life Sciences (DCV)Bahia State UniversitySalvadorBahiaBrazil
| | - Helen M. Cavalcanti
- Postgraduate Program in Health SciencesFederal University of Bahia School of MedicineSalvadorBahiaBrazil,Motor Behavior and Neurorehabilitation Research GroupBahiana School of Medicine and Public HealthSalvadorBahiaBrazil
| | - Jamary Oliveira‐Filho
- Postgraduate Program in Health SciencesFederal University of Bahia School of MedicineSalvadorBahiaBrazil
| | - Lorena Rosa S. Almeida
- Motor Behavior and Neurorehabilitation Research GroupBahiana School of Medicine and Public HealthSalvadorBahiaBrazil,Movement Disorders and Parkinson's Disease ClinicRoberto Santos General HospitalSalvadorBahiaBrazil
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13
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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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14
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Zhu S, Wu Z, Wang Y, Jiang Y, Gu R, Zhong M, Jiang X, Shen B, Zhu J, Yan J, Pan Y, Zhang L. Gait Analysis with Wearables Is a Potential Progression Marker in Parkinson's Disease. Brain Sci 2022; 12:1213. [PMID: 36138949 PMCID: PMC9497215 DOI: 10.3390/brainsci12091213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/17/2022] [Accepted: 09/05/2022] [Indexed: 11/17/2022] Open
Abstract
Gait disturbance is a prototypical feature of Parkinson's disease (PD), and the quantification of gait using wearable sensors is promising. This study aimed to identify gait impairment in the early and progressive stages of PD according to the Hoehn and Yahr (H-Y) scale. A total of 138 PD patients and 56 healthy controls (HCs) were included in our research. We collected gait parameters using the JiBuEn gait-analysis system. For spatiotemporal gait parameters and kinematic gait parameters, we observed significant differences in stride length (SL), gait velocity, the variability of SL, heel strike angle, and the range of motion (ROM) of the ankle, knee, and hip joints between HCs and PD patients in H-Y Ⅰ-Ⅱ. The changes worsened with the progression of PD. The differences in the asymmetry index of the SL and ROM of the hip were found between HCs and patients in H-Y Ⅳ. Additionally, these gait parameters were significantly associated with Unified Parkinson's Disease Rating Scale and Parkinson's Disease Questionnaire-39. This study demonstrated that gait impairment occurs in the early stage of PD and deteriorates with the progression of the disease. The gait parameters mentioned above may help to detect PD earlier and assess the progression of PD.
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Affiliation(s)
- Sha Zhu
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zhuang Wu
- Neurotoxin Research Center of Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Neurological Department of Tongji Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Yaxi Wang
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yinyin Jiang
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Ruxin Gu
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Min Zhong
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Xu Jiang
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Bo Shen
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Jun Zhu
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Jun Yan
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yang Pan
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Li Zhang
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
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15
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Shoulson I, Arbatti L, Hosamath A, Eberly SW, Oakes D. Longitudinal Cohort Study of Verbatim-Reported Postural Instability Symptoms as Outcomes for Online Parkinson’s Disease Trials. JOURNAL OF PARKINSON'S DISEASE 2022; 12:1969-1978. [PMID: 35694935 PMCID: PMC9535582 DOI: 10.3233/jpd-223274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The Parkinson’s Disease Patient Report of Problems (PD-PROP) captures the problems and functional impact that patients report verbatim. Online research participation and advances in language analysis have enabled longitudinal collection and classification of symptoms as trial outcomes. Objective: Analyze verbatim reports longitudinally to examine postural-instability symptoms as 1) precursors of subsequent falling and 2) newly occurring symptoms that could serve as outcome measures in randomized controlled trials. Methods: Problems reported by >25,000 PD patients in their own words were collected online in the Fox Insight observational study and classified into symptoms by natural language processing, clinical curation, and machine learning. Symptoms of gait, balance, falling, and freezing and associated reports of having fallen in the last month were analyzed over three years of longitudinal observation by a Cox regression model in a cohort of 8,287 participants. New onset of gait, balance, falling, and freezing symptoms was analyzed by Kaplan-Meier survival techniques in 4,119 participants who had not previously reported these symptoms. Results: Classified verbatim symptoms of postural instability were significant precursors of subsequent falling among participants who were older, female, and had longer PD duration. New onset of symptoms steadily increased and informed sample size estimates for clinical trials to reduce the onset of these symptoms. Conclusion: The tools to analyze symptoms reported by PD patients in their own words and capacity to enroll large numbers of research participants online support the feasibility and statistical power for conducting randomized clinical trials to detect effects of therapeutic interventions.
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Affiliation(s)
- Ira Shoulson
- Department of Neurology, University of Rochester, Rochester, NY, USA
- Grey Matter Technologies, Inc., Longboat Key, FL, USA
| | | | | | - Shirley W. Eberly
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
| | - David Oakes
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
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16
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Liu WY, Tung TH, Zhang C, Shi L. Systematic review for the prevention and management of falls and fear of falling in patients with Parkinson's disease. Brain Behav 2022; 12:e2690. [PMID: 35837986 PMCID: PMC9392538 DOI: 10.1002/brb3.2690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/17/2022] [Accepted: 04/24/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To synthesize recent empirical evidence for the prevention and management of falls and fear of falling in patients with Parkinson's disease (PD). DATA SOURCE Database from PubMed, Cochrane Library, and EMBASE. STUDY DESIGN Systematic review. DATA COLLECTION We searched the PubMed, Cochrane Library, and EMBASE databases for studies published from inception to February 27, 2021. Inclusion criteria were nonreview articles on prevention and management measures related to falls and fall prevention in Parkinson's disease patients. PRINCIPAL FINDINGS We selected 45 articles and conducted in-depth research and discussion. According to the causes of falls in PD patients, they were divided into five directions, namely physical status, pre-existing conditions, environment, medical care, and cognition. In the cognitive domain, we focused on the fear of falling. On the above basis, we constructed a fall prevention model, which is a tertiary prevention health care network, based on The Johns Hopkins Fall Risk Assessment Tool to provide ideas for the prevention and management of falling and fear of falling in PD patients in clinical practice CONCLUSIONS: Falls and fear of falls in patients with Parkinson's disease can be reduced by effective clinical prevention and management. Future studies are needed to explore the efficacy of treatment and prevention of falls and fear of falls.
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Affiliation(s)
- Wen-Yi Liu
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.,Shanghai Bluecross Medical Science Institute, Shanghai, China.,Institute for Hospital Management, Tsing Hua University, Shenzhen Campus, China
| | - Tao-Hsin Tung
- Evidence-based Medicine Center, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China
| | - Chencheng Zhang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Leiyu Shi
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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17
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Gait alterations in Parkinson’s disease at the stage of hemiparkinsonism—A longitudinal study. PLoS One 2022; 17:e0269886. [PMID: 35862311 PMCID: PMC9302743 DOI: 10.1371/journal.pone.0269886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/29/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Progressive gait impairment in Parkinson’s disease (PD) leads to significant disability. Quantitative gait parameters analysis provides valuable information about fine gait alterations.
Objectives
To analyse change of gait parameters in patients with early PD at the stage of hemiparkinsonism and after 1 year of follow up, taking into account clinical asymmetry.
Methods
Consecutive early PD outpatients with strictly unilateral motor features underwent clinical and neuropsychological assessment at the study entry and after 1 year of follow up. Gait was assessed with GAITRite walkway using dual-task methodology. Spatiotemporal gait parameters (step time and length, swing time and double support time) and their coefficients of variation (CV), gait velocity and heel-to-heel base support were evaluated.
Results
We included 42 PD patients with disease duration of 1.3 years (±1.13). Progression of motor and non-motor symptoms, without significant cognitive worsening, was observed after 1 year of follow up. Significant shortening of the swing time, prolongation of the double support and increase of their CVs were observed during all task conditions similarly for most parameters on symptomatic and asymptomatic bodysides, except for CV for the swing time under the combined task.
Conclusion
Alterations of the swing time and double support time are already present even at the asymptomatic body side, and progress similarly, or even at faster pace, at this side, despite dopaminergic treatment These parameters deserve further investigation in larger, prospective studies to address their potential to serve as markers of progression in interventional disease modifying trials with early PD patients.
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18
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Revuelta GJ, Embry A, Elm JJ, Jenkins S, Lee P, Kautz S. A feasibility study of objective outcome measures used in clinical trials of freezing of gait. Pilot Feasibility Stud 2022; 8:137. [PMID: 35787816 PMCID: PMC9252072 DOI: 10.1186/s40814-022-01092-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 06/15/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Freezing of gait (FOG) is notoriously difficult to quantify, which has led to the use of multiple markers as outcomes for clinical trials. The instrumented timed up and go (TUG) and the many parameters that can be derived from it are commonly used as objective markers of FOG severity in clinical trials; however, it is unknown if they represent actual FOG severity. OBJECTIVE To determine the specificity and responsiveness of objective surrogate markers of FOG severity commonly utilized in FOG studies. METHODS Study design: We compared the specificity and responsiveness of commonly used markers in FOG clinical trials. Markers compared included velocity, step/stride length, step/stride length variability, TUG, and turn duration. Data was collected in four conditions (ON and OFF dopaminergic drugs, with and without a dual task). Unified Parkinson's Disease Rating Scale (UPDRS) was administered in the ON and OFF states. RESULTS Thirty-three subjects were recruited (17 PD subjects without FOG (PD-control) and 16 subjects with PD and dopa-responsive FOG PD-FOG). The UPDRS motor scores were 24.9 for the PD-control group in the ON state, 24.8 for the FOG group in the ON state, and 42.4 for the FOG group in the OFF state. Significant mean differences between the ON and OFF conditions were observed with all surrogate markers (p < 0.01). However, only dual task turn duration and step variability showed trends toward significance when comparing PD-control and ON-FOG (p = 0.08). Test-retest reliability was high (ICC > 0.90) for all markers except standard deviations. Step length variability was the only marker to show an area under the ROC curve analysis > 0.70 comparing ON-FOG vs. PD-control. CONCLUSIONS Multiple candidate surrogate markers for FOG severity showed responsiveness to levodopa challenge; however, most were not specific for FOG severity.
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Affiliation(s)
- Gonzalo J Revuelta
- Movement Disorders Division, Department of Neurology, College of Medicine, Medical University of South Carolina, 208B Rutledge Avenue, MSC 108, Charleston, SC, 29425, USA.
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA.
| | - Aaron Embry
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA
- Center for Rehabilitation Research in Neurological Conditions, Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Jordan J Elm
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Shonna Jenkins
- Movement Disorders Division, Department of Neurology, College of Medicine, Medical University of South Carolina, 208B Rutledge Avenue, MSC 108, Charleston, SC, 29425, USA
| | - Philip Lee
- Movement Disorders Division, Department of Neurology, College of Medicine, Medical University of South Carolina, 208B Rutledge Avenue, MSC 108, Charleston, SC, 29425, USA
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
| | - Steve Kautz
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA
- Center for Rehabilitation Research in Neurological Conditions, Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
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Chuang CS, Chen YW, Zeng BY, Hung CM, Tu YK, Tai YC, Wu YC, Hsu CW, Lei WT, Wu SL, Stubbs B, Carvalho AF, Su KP, Chen TY, Tseng PT, Wu MK, Tsai CH. Effects of modern technology (exergame and virtual reality)-assisted rehabilitation vs conventional rehabilitation in patients with Parkinson’s disease: a network meta-analysis of randomised controlled trials. Physiotherapy 2022; 117:35-42. [DOI: 10.1016/j.physio.2022.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 06/04/2022] [Accepted: 07/12/2022] [Indexed: 01/08/2023]
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20
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Bonci T, Salis F, Scott K, Alcock L, Becker C, Bertuletti S, Buckley E, Caruso M, Cereatti A, Del Din S, Gazit E, Hansen C, Hausdorff JM, Maetzler W, Palmerini L, Rochester L, Schwickert L, Sharrack B, Vogiatzis I, Mazzà C. An Algorithm for Accurate Marker-Based Gait Event Detection in Healthy and Pathological Populations During Complex Motor Tasks. Front Bioeng Biotechnol 2022; 10:868928. [PMID: 35721859 PMCID: PMC9201978 DOI: 10.3389/fbioe.2022.868928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
There is growing interest in the quantification of gait as part of complex motor tasks. This requires gait events (GEs) to be detected under conditions different from straight walking. This study aimed to propose and validate a new marker-based GE detection method, which is also suitable for curvilinear walking and step negotiation. The method was first tested against existing algorithms using data from healthy young adults (YA, n = 20) and then assessed in data from 10 individuals from the following five cohorts: older adults, chronic obstructive pulmonary disease, multiple sclerosis, Parkinson’s disease, and proximal femur fracture. The propagation of the errors associated with GE detection on the calculation of stride length, duration, speed, and stance/swing durations was investigated. All participants performed a variety of motor tasks including curvilinear walking and step negotiation, while reference GEs were identified using a validated methodology exploiting pressure insole signals. Sensitivity, positive predictive values (PPV), F1-score, bias, precision, and accuracy were calculated. Absolute agreement [intraclass correlation coefficient (ICC2,1)] between marker-based and pressure insole stride parameters was also tested. In the YA cohort, the proposed method outperformed the existing ones, with sensitivity, PPV, and F1 scores ≥ 99% for both GEs and conditions, with a virtually null bias (<10 ms). Overall, temporal inaccuracies minimally impacted stride duration, length, and speed (median absolute errors ≤1%). Similar algorithm performances were obtained for all the other five cohorts in GE detection and propagation to the stride parameters, where an excellent absolute agreement with the pressure insoles was also found (ICC2,1=0.817− 0.999). In conclusion, the proposed method accurately detects GE from marker data under different walking conditions and for a variety of gait impairments.
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Affiliation(s)
- Tecla Bonci
- Department of Mechanical Engineering, Insigno Institute for In Silico Medicine, The University of Sheffield, Sheffield, United Kingdom
- *Correspondence: Tecla Bonci,
| | - Francesca Salis
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Kirsty Scott
- Department of Mechanical Engineering, Insigno Institute for In Silico Medicine, The University of Sheffield, Sheffield, United Kingdom
| | - Lisa Alcock
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Clemens Becker
- Department for Geriatric Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Stefano Bertuletti
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Ellen Buckley
- Department of Mechanical Engineering, Insigno Institute for In Silico Medicine, The University of Sheffield, Sheffield, United Kingdom
| | - Marco Caruso
- Department of Electronics and Telecommunications, Politecnico Di Torino, Torino, Italy
| | - Andrea Cereatti
- Department of Electronics and Telecommunications, Politecnico Di Torino, Torino, Italy
| | - Silvia Del Din
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Eran Gazit
- Centre for the Study of Movement, Cognition and Mobility, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel
| | - Clint Hansen
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel University, Kiel, Germany
| | - Jeffrey M. Hausdorff
- Centre for the Study of Movement, Cognition and Mobility, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel
- Department of Physical Therapy, Sackler Faculty of Medicine, Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Department of Orthopaedic Surgery, Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States
| | - Walter Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel University, Kiel, Germany
| | - Luca Palmerini
- Department of Electrical, Electronic, and Information Engineering “Guglielmo Marconi”, University of Bologna, Bologna, Italy
- Health Sciences and Technologies–Interdepartmental Center for Industrial Research (CIRI-SDV), University of Bologna, Bologna, Italy
| | - Lynn Rochester
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Lars Schwickert
- Department for Geriatric Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Basil Sharrack
- Department of Neuroscience, Sheffield NIHR Translational Neuroscience BRC, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne, United Kingdom
| | - Claudia Mazzà
- Department of Mechanical Engineering, Insigno Institute for In Silico Medicine, The University of Sheffield, Sheffield, United Kingdom
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21
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Zhu S, Wang Y, Jiang Y, Gu R, Zhong M, Jiang X, Shen B, Zhu J, Yan J, Pan Y, Zhang L. Clinical Features in Parkinson's Disease Patients with Hyperechogenicity in Substantia Nigra: A Cross-Sectional Study. Neuropsychiatr Dis Treat 2022; 18:1593-1601. [PMID: 35942277 PMCID: PMC9356622 DOI: 10.2147/ndt.s374370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/21/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Transcranial ultrasound (TCS) can be used to reveal structural changes in the substantia nigra (SN) and is a potential tool for the early diagnosis of Parkinson's disease (PD). This study aimed to explore the relationship between substantia nigra hyperechogenicity (SNH) and the clinical features of PD patients. METHODS A total of 96 PD patients were included in our study. All patients were detected by TCS and divided into two groups: PD patients with SNH (PDSN+) and those with normal SN echogenicity (PDSN-). The Unified Parkinson's Disease Rating Scale (UPDRS) and the Hoehn & Yahr stage were used to assess the extent of disease-related disability of the PD patients. Non-motor symptoms were evaluated by using several scales. The instrumented stand and walk test was performed on all subjects, and gait data were gathered using a JiBuEn gait analysis system. RESULTS Seventy-five PD patients were successfully assessed by TCS. We found that SNH was associated with a higher UPDRS II scores (p = 0.028). In addition, compared with PDSN- group, the PDSN+ group exhibited more severe gait impairment, including increased variability in stride length (p = 0.042), decreased heel strike angle (p = 0.017), decreased range of motion of hip joints (p = 0.031), and a more asymmetrical walking pattern (p = 0.028). CONCLUSION Our study demonstrated that SNH significantly correlated with activities of daily living and gait impairment in Chinese patients with PD, suggesting the formation of SNH might be a dynamic biomarker reflecting disease severity.
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Affiliation(s)
- Sha Zhu
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Yaxi Wang
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Yinyin Jiang
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Ruxin Gu
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Min Zhong
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Xu Jiang
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Bo Shen
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Jun Zhu
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Jun Yan
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Yang Pan
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Li Zhang
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People's Republic of China
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22
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Shearin S, Braitsch M, Querry R. The effect of a multi-modal boxing exercise program on cognitive locomotor tasks and gait in persons with Parkinson disease. NeuroRehabilitation 2021; 49:619-627. [PMID: 34806626 DOI: 10.3233/nre-210218] [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: 11/15/2022]
Abstract
BACKGROUND Parkinson disease (PD) is a progressive neurological disease resulting in motor impairments, postural instability, and gait alterations which may result in self-care limitations and loss of mobility reducing quality of life. OBJECTIVE This study's purpose was to determine the impact of a community-based boxing program on gait parameters, dual task and backwards walking in individuals with PD. METHODS This study included 26 community dwelling individuals with PD who participated in 12-week boxing classes (1 hour, 2 times a week). The focus was on upper/lower extremity exercises using punching bags, agility drills, and strengthening activities. Pre/post testing was performed for dual task and gait parameters and was analyzed using t-tests. RESULTS Analysis of the scores indicated participants performed significantly better at post-test compared to pre-test on self-selected walking velocity (P = 0.041), cadence (P = 0.021); backwards walking velocity (P = 0.003), step length (P = 0.022); dual task walking velocity (P = 0.044), step length (P = 0.023), and gait variability index (P = 0.008). No significant differences for fast walking. CONCLUSIONS Multi-modal boxing produced improvements in gait velocity, dual task velocity, step length, and gait variability, as well as backwards walking velocity and step length. These improvements may impact independence with functional mobility and may improve safety but require further studies.
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Affiliation(s)
- Staci Shearin
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Ross Querry
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
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23
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Zhou H, Nguyen H, Enriquez A, Morsy L, Curtis M, Piser T, Kenney C, Stephen CD, Gupta AS, Schmahmann JD, Vaziri A. Assessment of gait and balance impairment in people with spinocerebellar ataxia using wearable sensors. Neurol Sci 2021; 43:2589-2599. [PMID: 34664180 DOI: 10.1007/s10072-021-05657-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 10/05/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To explore the use of wearable sensors for objective measurement of motor impairment in spinocerebellar ataxia (SCA) patients during clinical assessments of gait and balance. METHODS In total, 14 patients with genetically confirmed SCA (mean age 61.6 ± 8.6 years) and 4 healthy controls (mean age 49.0 ± 16.4 years) were recruited through the Massachusetts General Hospital (MGH) Ataxia Center. Participants donned seven inertial sensors while performing two independent trials of gait and balance assessments from the Scale for the Assessment and Rating of Ataxia (SARA) and Brief Ataxia Rating Scale (BARS2). Univariate analysis was used to identify sensor-derived metrics from wearable sensors that discriminate motor function between the SCA and control groups. Multivariate linear regression models were used to estimate the subjective in-person SARA/BARS2 ratings. Spearman correlation coefficients were used to evaluate the performance of the model. RESULTS Stride length variability, stride duration, cadence, stance phase, pelvis sway, and turn duration were different between SCA and controls (p < 0.05). Similarly, sway and sway velocity of the ankle, hip, and center of mass differentiated SCA and controls (p < 0.05). Using these features, linear regression models showed moderate-to-strong correlation with clinical scores from the in-person rater during SARA assessments of gait (r = 0.73, p = 0.003) and stance (r = 0.90, p < 0.001) and the BARS2 gait assessment (r = 0.74, p = 0.003). CONCLUSION This study demonstrates that sensor-derived metrics can potentially be used to estimate the level of motor impairment in patient with SCA quickly and objectively. Thus, digital biomarkers from wearable sensors have the potential to be an integral tool for SCA clinical trials and care.
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Affiliation(s)
- He Zhou
- BioSensics LLC, Newton, MA, USA
| | | | | | | | | | | | | | - Christopher D Stephen
- Ataxia Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Anoopum S Gupta
- Ataxia Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Jeremy D Schmahmann
- Ataxia Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
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24
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Sarasso E, Gardoni A, Piramide N, Volontè MA, Canu E, Tettamanti A, Filippi M, Agosta F. Dual-task clinical and functional MRI correlates in Parkinson's disease with postural instability and gait disorders. Parkinsonism Relat Disord 2021; 91:88-95. [PMID: 34547654 DOI: 10.1016/j.parkreldis.2021.09.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 09/01/2021] [Accepted: 09/06/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Dual-task is a challenge for Parkinson's disease patients with postural instability and gait disorders (PD-PIGD). OBJECTIVE This study investigated clinical, cognitive and functional brain correlates of dual-task deficits in PD-PIGD patients using quantitative gait analysis, neuropsychological evaluations and functional MRI (fMRI). METHODS Twenty-three PD-PIGD patients performed a clinical assessment of gait/balance abilities. Single and dual-task Timed-Up-and-Go tests were monitored using an optoelectronic system to study turning velocity. Patients underwent executive-attentive function evaluation and two fMRI tasks: motor-task (foot anti-phase movements), and dual-task (foot anti-phase movements while counting backwards by threes starting from 100). Twenty-three healthy subjects underwent neuropsychological and fMRI assessments. RESULTS Dual-task in PD-PIGD patients resulted in worse gait performance, particularly during turning. Performing the dual-task relative to the motor-fMRI task, healthy subjects showed widespread increased recruitment of sensorimotor, cognitive and cerebellar areas and reduced activity of inferior frontal and supramarginal gyri, while PD-PIGD patients showed increased recruitment of inferior frontal gyrus and supplementary motor area and reduced activity of primary motor, supramarginal and caudate areas. Dual-task gait alterations in patients correlated with balance and executive deficits and with altered dual-task fMRI brain activity of frontal areas. CONCLUSIONS This study suggested the correlation between dual-task gait difficulties, postural instability and executive dysfunction in PD-PIGD patients. FMRI results suggest that an optimized recruitment of motor and cognitive networks is associated with a better dual-task performance in PD-PIGD. Future studies should evaluate the effect of specific gait/balance and dual-task trainings to improve gait parameters and optimize brain functional activity during dual-tasks.
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Affiliation(s)
- Elisabetta Sarasso
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Gardoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Noemi Piramide
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | | | - Elisa Canu
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Tettamanti
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
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25
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Sarasso E, Agosta F, Piramide N, Gardoni A, Canu E, Leocadi M, Castelnovo V, Basaia S, Tettamanti A, Volontè MA, Filippi M. Action Observation and Motor Imagery Improve Dual Task in Parkinson's Disease: A Clinical/fMRI Study. Mov Disord 2021; 36:2569-2582. [PMID: 34286884 DOI: 10.1002/mds.28717] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Action observation training and motor imagery may improve motor learning in Parkinson's disease (PD). OBJECTIVES The objectives of this study were to assess mobility and balance (performing motor and dual tasks) and brain functional reorganization following 6 weeks of action observation training and motor imagery associated with dual-task gait/balance exercises in PD patients with postural instability and gait disorders relative to dual-task training alone. METHODS Twenty-five PD-postural instability and gait disorder patients were randomized into 2 groups: the DUAL-TASK+AOT-MI group performed a 6-week gait/balance training consisting of action observation training-motor imagery combined with practicing the observed-imagined exercises; the DUAL-TASK group performed the same exercises combined with watching landscape videos. Exercises were increasingly difficult to include the dual task. At baseline and at 6 weeks, patients underwent: mobility, gait, and balance evaluations (also repeated 2 months after training), cognitive assessment, and functional MRI, including motor and dual tasks. RESULTS Dual-task gait/balance training enhanced mobility, during both single- and dual-task conditions, and executive functions in PD-postural instability and gait disorders, with a long-lasting effect at 14 weeks. When exercises were preceded by action observation training-motor imagery, PD-postural instability and gait disorders showed greater improvement of balance and gait velocity both with and without the dual task, particularly during the turning phase. After training, the DUAL-TASK+AOT-MI group showed reduced recruitment of frontal areas and increased activity of cerebellum during functional-MRI motor and dual task, correlating with balance/turning velocity and executive improvements, respectively. The DUAL-TASK group showed reduced activity of supplementary motor area and increased recruitment of temporo-parietal areas during the dual task and decreased cerebellar activity during the motor task correlating with faster turning velocity. Functional MRI results were not corrected for multiple comparisons and should be interpreted carefully. CONCLUSIONS Adding action observation training-motor imagery to dual-task gait/balance training promotes specific functional reorganization of brain areas involved in motor control and executive-attentive abilities and more long-lasting effects on dual-task mobility and balance in PD-postural instability and gait disorders. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Elisabetta Sarasso
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Noemi Piramide
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Gardoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisa Canu
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Michela Leocadi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Veronica Castelnovo
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Silvia Basaia
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Tettamanti
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy.,Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
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26
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Wang H, Li HY, Guo X, Zhou Y. Posture Instability Is Associated with Dopamine Drop of Nigrostriatal System and Hypometabolism of Cerebral Cortex in Parkinson Disease. Curr Neurovasc Res 2021; 18:244-253. [PMID: 34082681 DOI: 10.2174/1567202618666210603124814] [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: 01/25/2021] [Revised: 02/06/2021] [Accepted: 02/08/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Posture instability (PI) is known to be a severe complication in Parkinson's disease (PD), and its mechanism remains poorly understood. Our study aims to explore the changes of brain network in PI of PD, and further investigate the role of peripheral inflammation on activities of different brain regions in PD with PI. METHODS 167 individuals were recruited, including 36 PD cases with PI and 131 ones without PI. We carefully assessed the status of motor and cognitive function, measured serum inflammatory factors, and detected the dopaminergic pathways and the metabolism of different brain regions by positron emission tomography (PET). Data analysis was conducted by variance, univariate analysis, chi-square analysis, logistic regression, and partial correlation. RESULT No difference was found for age or onset age between the two groups (P>0.05). Female patients were susceptible to posture impairment and had a 2.14-fold risk for PI compared with male patients in PD (P<0.05). Patients with PI had more severe impairment of motor and cognitive function for a longer duration than those without PI (P<0.05). The mean uptake ratios of presynaptic vesicular monoamine transporter (VMAT2), which were detected in the caudate nucleus and putamen, were lower in PI group than those without PI (P<0.05). There were lower activities of the midbrain, caudate nucleus, and anterior medial temporal cortex in PI group than those in the non-PI group (P<0.05). Although serum concentrations of immunoglobulins (IgG, IgM, and IgA) and complements (C3, C4) were higher in PI group than those in the non-PI group, only serum IgM concentration had a significant difference between the two groups (P<0.05). We further explored significant inverse correlations of IgG, IgM, IgA, and C4 with activities of some cerebral cortex in PI of PD (P<0.05). CONCLUSION Female patients were susceptible to posture instability and had a 2.14-fold risk for PI of PD. Patients with PI had more severe impairments of motor and cognitive function for a longer duration than those without PI. PI was associated with dopamine drop of the nigrostriatal system and lower activities of the limbic cortex in PD. Peripheral inflammation may be involved in degeneration of the cerebral cortex in PD combined with PI.
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Affiliation(s)
- Hongyan Wang
- The Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing 10053, China
| | - Hong-Yu Li
- School of Pharmacy, Lanzhou University, Lanzhou 730000, China
| | - Xiuhai Guo
- The Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing 10053, China
| | - Yongtao Zhou
- The Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing 10053, China
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27
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Mild Gait Impairment and Its Potential Diagnostic Value in Patients with Early-Stage Parkinson's Disease. Behav Neurol 2021; 2021:6696454. [PMID: 33884040 PMCID: PMC8041560 DOI: 10.1155/2021/6696454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/20/2021] [Indexed: 11/17/2022] Open
Abstract
Methods 32 patients with early-stage PD and 30 healthy control subjects (HC) were enrolled. All participants completed the instrumented stand and walk test, and gait data was collected using wearable sensors. Results We observed increased variability of stride length (SL) (P < 0.001), stance phase time (StPT) (P = 0.004), and swing phase time (SwPT) (P = 0.011) in PD. There were decreased heel strike (HS) (P = 0.001), range of motion of knee (P = 0.036), and hip joints (P < 0.001) in PD. In symmetry analysis, no difference was found in any of the assessed gait parameters between HC and PD. Only total steps (AUC = 0.763, P < 0.001), SL (AUC = 0.701, P = 0.007), SL variability (AUC = 0.769, P < 0.001), StPT variability (AUC = 0.712, P = 0.004), and SwPT variability (AUC = 0.688, P = 0.011) had potential diagnostic value. When these five gait parameters were combined, the predictive power was found to increase, with the highest AUC of 0.802 (P < 0.001). Conclusions Patients with early-stage PD presented increased variability but still symmetrical gait pattern. Some specific gait parameters can be applied to diagnose early-stage PD which may increase diagnosis accuracy. Our findings are helpful to improve patient's quality of life.
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28
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Wilson J, Yarnall AJ, Craig CE, Galna B, Lord S, Morris R, Lawson RA, Alcock L, Duncan GW, Khoo TK, O'Brien JT, Burn DJ, Taylor J, Ray NJ, Rochester L. Cholinergic Basal Forebrain Volumes Predict Gait Decline in Parkinson's Disease. Mov Disord 2021; 36:611-621. [PMID: 33382126 PMCID: PMC8048433 DOI: 10.1002/mds.28453] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/28/2020] [Accepted: 11/16/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Gait disturbance is an early, disabling feature of Parkinson's disease (PD) that is typically refractory to dopaminergic medication. The cortical cholinergic system, originating in the nucleus basalis of Meynert of the basal forebrain, has been implicated. However, it is not known if degeneration in this region relates to a worsening of disease-specific gait impairment. OBJECTIVE To evaluate associations between sub-regional cholinergic basal forebrain volumes and longitudinal progression of gait impairment in PD. METHODS 99 PD participants and 47 control participants completed gait assessments via an instrumented walkway during 2 minutes of continuous walking, at baseline and for up to 3 years, from which 16 spatiotemporal characteristics were derived. Sub-regional cholinergic basal forebrain volumes were measured at baseline via MRI and a regional map derived from post-mortem histology. Univariate analyses evaluated cross-sectional associations between sub-regional volumes and gait. Linear mixed-effects models assessed whether volumes predicted longitudinal gait changes. RESULTS There were no cross-sectional, age-independent relationships between sub-regional volumes and gait. However, nucleus basalis of Meynert volumes predicted longitudinal gait changes unique to PD. Specifically, smaller nucleus basalis of Meynert volume predicted increasing step time variability (P = 0.019) and shortening swing time (P = 0.015); smaller posterior nucleus portions predicted shortening step length (P = 0.007) and increasing step time variability (P = 0.041). CONCLUSIONS This is the first study to demonstrate that degeneration of the cortical cholinergic system predicts longitudinal progression of gait impairments in PD. Measures of this degeneration may therefore provide a novel biomarker for identifying future mobility loss and falls. © 2020 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Joanna Wilson
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUnited Kingdom
| | - Alison J. Yarnall
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUnited Kingdom
- The Newcastle upon Tyne NHS Foundation TrustNewcastle upon TyneUnited Kingdom
| | - Chesney E. Craig
- Health, Psychology and Communities Research Centre, Department of PsychologyManchester Metropolitan UniversityManchesterUnited Kingdom
| | - Brook Galna
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUnited Kingdom
- School of Biomedical, Nutritional and Sport SciencesNewcastle UniversityNewcastle upon TyneUnited Kingdom
| | - Sue Lord
- Auckland University of TechnologyAucklandNew Zealand
| | - Rosie Morris
- Department of Sport, Exercise, and RehabilitationNorthumbria UniversityNewcastle upon TyneUnited Kingdom
| | - Rachael A. Lawson
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUnited Kingdom
| | - Lisa Alcock
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUnited Kingdom
| | - Gordon W. Duncan
- Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUnited Kingdom
- NHS LothianEdinburghUnited Kingdom
| | - Tien K. Khoo
- School of Medicine & Menzies Health Institute QueenslandGriffith UniversityGold CoastQueenslandAustralia
- School of Medicine, University of WollongongAustralia
| | - John T. O'Brien
- Department of PsychiatryUniversity of CambridgeCambridgeUnited Kingdom
| | - David J. Burn
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUnited Kingdom
| | - John‐Paul Taylor
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUnited Kingdom
| | - Nicola J. Ray
- Health, Psychology and Communities Research Centre, Department of PsychologyManchester Metropolitan UniversityManchesterUnited Kingdom
| | - Lynn Rochester
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUnited Kingdom
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Halperin O, Karni R, Israeli-Korn S, Hassin-Baer S, Zaidel A. Overconfidence in visual perception in parkinson's disease. Eur J Neurosci 2021; 53:2027-2039. [PMID: 33368717 DOI: 10.1111/ejn.15093] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/04/2020] [Accepted: 12/18/2020] [Indexed: 01/23/2023]
Abstract
Increased dependence on visual cues in Parkinson's disease (PD) can unbalance the perception-action loop, impair multisensory integration, and affect everyday function of PD patients. It is currently unknown why PD patients seem to be more reliant on their visual cues. We hypothesized that PD patients may be overconfident in the reliability (precision) of their visual cues. In this study we tested coherent visual motion perception in PD, and probed subjective (self-reported) confidence in their visual motion perception. Twenty patients with idiopathic PD, 21 healthy aged-matched controls and 20 healthy young adult participants were presented with visual stimuli of moving dots (random dot kinematograms). They were asked to report: (1) whether the aggregate motion of dots was to the left or to the right, and (2) how confident they were that their perceptual discrimination was correct. Visual motion discrimination thresholds were similar (unimpaired) in PD compared to the other groups. By contrast, PD patients were significantly overconfident in their visual perceptual decisions (p = .002 and p < .001 vs. the age-matched and young adult groups, respectively). These results suggest intact visual motion perception, but overestimation of visual cue reliability, in PD. Overconfidence in visual (vs. other, e.g., somatosensory) cues could underlie increased visual dependence and impaired multisensory/sensorimotor integration in PD. It could thereby contribute to gait and balance impairments, and affect everyday activities, such as driving. Future work should investigate and compare PD confidence in somatosensory function. A better understanding of altered sensory reliance might open up new avenues to treat debilitating PD symptoms.
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Affiliation(s)
- Orly Halperin
- Gonda Multidisciplinary Brain Research Center, Bar Ilan University, Ramat Gan, Israel
| | - Roie Karni
- Gonda Multidisciplinary Brain Research Center, Bar Ilan University, Ramat Gan, Israel
| | - Simon Israeli-Korn
- Movement Disorders Institute and the Department of Neurology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Hassin-Baer
- Movement Disorders Institute and the Department of Neurology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adam Zaidel
- Gonda Multidisciplinary Brain Research Center, Bar Ilan University, Ramat Gan, Israel
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30
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Zeigelboim BS, José MR, Severiano MIR, Santos GJBD, Teive HAG, Liberalesso PBN, Marques JM, Rosa MRD, Santos RS, Malisky JS. The Use of Exergames in the Neurorehabilitation of People with Parkinson Disease: The Impact on Daily Life. Int Arch Otorhinolaryngol 2021; 25:e64-e70. [PMID: 33542753 PMCID: PMC7850887 DOI: 10.1055/s-0040-1702973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 12/26/2019] [Indexed: 10/29/2022] Open
Abstract
Introduction Parkinson disease (PD) is a progressive degeneration characterized by motor disorders, such as tremor, bradykinesia, stiffness and postural instability. Objective To evaluate the independence, confidence and balance in the development of daily activities in patients with PD before and after rehabilitation. Methods A descriptive, retrospective cross-sectional study was carried out with 16 patients (mean 57.6 ± 18.7 years), submitted to anamnesis, otolaryngological evaluation and vestibular assessment. The Vestibular Disorders Activities of Daily Living (VADL) and the Activities-Specific Balance Confidence (ABC) scales were applied before and after rehabilitation with virtual reality. Results a) The instrumental subscale of the questionnaire showed statistically significant result ( p = 0.022; 95% CI 1.21; 2.21) between the first and second assessments; b) The correlation between the questionnaires showed statistically significant result in the ambulation subscale ( p = 0.011; 95% CI -0.85; -0.17) first and ( p = 0.002, 95% CI -0.88; -0.31) second assessments, and the functional subscale was only verified in the second assessment ( p = 0.011, 95% CI -0.85; -0.17); and c) The patients presented clinical improvement in the final assessment after rehabilitation with significant result for the tightrope walk ( p = 0.034, 95% CI -12.5; -0.3) and ski slalom games ( p = 0.005, 95% CI -34.8; -6.6). Conclusions Our results showed that the VADL and ABC questionnaires, applied before and after rehabilitation, were important tools to measure the independence, confidence and balance while developing daily activities. The VADL and ABC questionnaires may effectively contribute to quantify the effect of the applied therapeutics and, consequently, its impact on the quality of life of patients with PD.
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Affiliation(s)
| | - Maria Renata José
- Department of Otoneurology, Universidade Tuiuti do Paraná (UTP), Curitiba, PR, Brazil
| | | | | | | | | | - Jair Mendes Marques
- Department of Otoneurology, Universidade Tuiuti do Paraná (UTP), Curitiba, PR, Brazil
| | | | - Rosane Sampaio Santos
- Department of Otoneurology, Universidade Tuiuti do Paraná (UTP), Curitiba, PR, Brazil
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31
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Wilson J, Alcock L, Yarnall AJ, Lord S, Lawson RA, Morris R, Taylor JP, Burn DJ, Rochester L, Galna B. Gait Progression Over 6 Years in Parkinson's Disease: Effects of Age, Medication, and Pathology. Front Aging Neurosci 2020; 12:577435. [PMID: 33192470 PMCID: PMC7593770 DOI: 10.3389/fnagi.2020.577435] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/09/2020] [Indexed: 01/02/2023] Open
Abstract
Background: Gait disturbance is an early, cardinal feature of Parkinson's disease (PD) associated with falls and reduced physical activity. Progression of gait impairment in Parkinson's disease is not well characterized and a better understanding is imperative to mitigate impairment. Subtle gait impairments progress in early disease despite optimal dopaminergic medication. Evaluating gait disturbances over longer periods, accounting for typical aging and dopaminergic medication changes, will enable a better understanding of gait changes and inform targeted therapies for early disease. This study aimed to describe gait progression over the first 6 years of PD by delineating changes associated with aging, medication, and pathology. Methods: One-hundred and nine newly diagnosed PD participants and 130 controls completed at least two gait assessments. Gait was assessed at 18-month intervals for up to 6 years using an instrumented walkway to measure sixteen spatiotemporal gait characteristics. Linear mixed-effects models assessed progression. Results: Ten gait characteristics significantly progressed in PD, with changes in four of these characteristics attributable to disease progression. Age-related changes also contributed to gait progression; changes in another two characteristics reflected both aging and disease progression. Gait impairment progressed irrespective of dopaminergic medication change for all characteristics except step width variability. Conclusions: Discrete gait impairments continue to progress in PD over 6 years, reflecting a combination of, and potential interaction between, disease-specific progression and age-related change. Gait changes were mostly unrelated to dopaminergic medication adjustments, highlighting limitations of current dopaminergic therapy and the need to improve interventions targeting gait decline.
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Affiliation(s)
- Joanna Wilson
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Lisa Alcock
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Alison J Yarnall
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom.,The Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Sue Lord
- Auckland University of Technology, Auckland, New Zealand
| | - Rachael A Lawson
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rosie Morris
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - David J Burn
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Lynn Rochester
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom.,The Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Brook Galna
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom.,School of Biomedical, Nutritional and Sport Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
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32
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The feasibility and validity of a wearable sensor system to assess the stability of high-functioning lower-limb prosthesis users. ACTA ACUST UNITED AC 2020; Online first. [PMID: 33510564 DOI: 10.1097/jpo.0000000000000332] [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] [Indexed: 11/25/2022]
Abstract
Introduction Lower-limb prosthesis users (LLPUs) experience increased fall risk due to gait and balance impairments. Clinical outcome measures are useful for measuring balance impairment and fall risk screening but suffer from limited resolution and ceiling effects. Recent advances in wearable sensors that can measure different components of gait stability may address these limitations. This study assessed feasibility and construct validity of a wearable sensor system (APDM Mobility Lab) to measure postural control and gait stability. Materials and Methods Lower-limb prosthesis users (n=22) and able-bodied controls (n=24) completed an Instrumented Stand-and-Walk Test (ISAW) while wearing the wearable sensors. Known-groups analysis (prosthesis versus controls) and convergence analysis (Prosthetic Limb Users Survey of Mobility [PLUS-M] and Activity-specific Balance Confidence [ABC] Scale) were performed on 20 stability-related measures. Results The system was applied without complications; however missing anticipatory postural adjustment data points for nine subjects affected the analysis. Of the 20 analyzed measures output by the sensors, only three significantly differed (p≤.05) between cohorts, and two demonstrated statistically significant correlations with the self-report measures. Conclusions The results of this study suggest the clinical feasibility but only partial construct validity of the wearable sensor system in conjunction with the ISAW test to measure LLPU stability and balance. The sample consisted of high-functioning LLPUs, so further research should evaluate a more representative sample with additional outcome measures and tasks.
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33
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Fifteen Years of Wireless Sensors for Balance Assessment in Neurological Disorders. SENSORS 2020; 20:s20113247. [PMID: 32517315 PMCID: PMC7308812 DOI: 10.3390/s20113247] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/25/2020] [Accepted: 06/03/2020] [Indexed: 12/12/2022]
Abstract
Balance impairment is a major mechanism behind falling along with environmental hazards. Under physiological conditions, ageing leads to a progressive decline in balance control per se. Moreover, various neurological disorders further increase the risk of falls by deteriorating specific nervous system functions contributing to balance. Over the last 15 years, significant advancements in technology have provided wearable solutions for balance evaluation and the management of postural instability in patients with neurological disorders. This narrative review aims to address the topic of balance and wireless sensors in several neurological disorders, including Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, stroke, and other neurodegenerative and acute clinical syndromes. The review discusses the physiological and pathophysiological bases of balance in neurological disorders as well as the traditional and innovative instruments currently available for balance assessment. The technical and clinical perspectives of wearable technologies, as well as current challenges in the field of teleneurology, are also examined.
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34
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Chung YC, Lewthwaite R, Winstein CJ, Monterosso JR, Fisher BE. Expectancy and affective response to challenging balance practice conditions in individuals with Parkinson's disease. Eur J Neurosci 2020; 52:3652-3662. [PMID: 32176392 DOI: 10.1111/ejn.14723] [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: 07/05/2019] [Revised: 02/10/2020] [Accepted: 03/03/2020] [Indexed: 11/27/2022]
Abstract
Psychological states can influence motor performance and learning. In Parkinson's disease (PD), placebo effects or expectancies for pharmacological treatment benefits are not uncommon, but little is known about whether self-efficacy, beliefs about personal performance capabilities, may play a role in this population. To address this question, we investigated whether experimental manipulations designed to enhance self-efficacy would benefit motor performance and learning in PD. A motor learning paradigm was utilized to determine the short-term (i.e., practice) and longer-term (i.e., retention) impact of self-efficacy enhancement when 44 individuals with PD (Hoehn and Yahr stage I-III) acquired a challenging balance skill. Using stratified randomization by Hoehn and Yahr stage, participants were assigned to a control group or one of two investigational groups: (a) an expectancy-relevant statement that encouraged an incremental mindset in which the balance skill, though initially challenging, was acquirable with practice (incremental theory group, IT), and (b) the expectancy-relevant statement in combination with a criterion for successful performance (incremental theory plus success criteria group, IT + SC). All groups improved their balance performance, but contrary to expectations, investigational groups did not outperform the control group at practice or retention. Unexpectedly, the IT + SC group reported greater nervousness than the control and IT groups, suggesting that the employed success criteria may have induced performance-related anxiety. Regression analyses revealed that self-efficacy increase from initial practice predicted performance at the end of practice and at retention. These findings highlight the potential contribution of psychological factors on motor function and rehabilitation in individuals with PD.
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Affiliation(s)
- Yu-Chen Chung
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Rebecca Lewthwaite
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA.,Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
| | - Carolee J Winstein
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA.,Department of Neurology, University of Southern California, Los Angeles, CA, USA
| | - John R Monterosso
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Beth E Fisher
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA.,Department of Neurology, University of Southern California, Los Angeles, CA, USA
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35
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Dinesh K, Snyder CW, Xiong M, Tarolli CG, Sharma S, Dorsey ER, Sharma G, Adams JL. A Longitudinal Wearable Sensor Study in Huntington’s Disease. J Huntingtons Dis 2020; 9:69-81. [DOI: 10.3233/jhd-190375] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Karthik Dinesh
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, USA
| | - Christopher W. Snyder
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - Mulin Xiong
- Michigan State University College of Human Medicine, East Lansing, MI, USA
| | - Christopher G. Tarolli
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Saloni Sharma
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - E. Ray Dorsey
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Gaurav Sharma
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, USA
| | - Jamie L. Adams
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
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36
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Dorsey ER, Omberg L, Waddell E, Adams JL, Adams R, Ali MR, Amodeo K, Arky A, Augustine EF, Dinesh K, Hoque ME, Glidden AM, Jensen-Roberts S, Kabelac Z, Katabi D, Kieburtz K, Kinel DR, Little MA, Lizarraga KJ, Myers T, Riggare S, Rosero SZ, Saria S, Schifitto G, Schneider RB, Sharma G, Shoulson I, Stevenson EA, Tarolli CG, Luo J, McDermott MP. Deep Phenotyping of Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2020; 10:855-873. [PMID: 32444562 PMCID: PMC7458535 DOI: 10.3233/jpd-202006] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/01/2020] [Indexed: 12/13/2022]
Abstract
Phenotype is the set of observable traits of an organism or condition. While advances in genetics, imaging, and molecular biology have improved our understanding of the underlying biology of Parkinson's disease (PD), clinical phenotyping of PD still relies primarily on history and physical examination. These subjective, episodic, categorical assessments are valuable for diagnosis and care but have left gaps in our understanding of the PD phenotype. Sensors can provide objective, continuous, real-world data about the PD clinical phenotype, increase our knowledge of its pathology, enhance evaluation of therapies, and ultimately, improve patient care. In this paper, we explore the concept of deep phenotyping-the comprehensive assessment of a condition using multiple clinical, biological, genetic, imaging, and sensor-based tools-for PD. We discuss the rationale for, outline current approaches to, identify benefits and limitations of, and consider future directions for deep clinical phenotyping.
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Affiliation(s)
- E. Ray Dorsey
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Emma Waddell
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - Jamie L. Adams
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Roy Adams
- Machine Learning, AI and Healthcare Lab, Johns Hopkins University, Baltimore, MD, USA
| | | | - Katherine Amodeo
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Abigail Arky
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - Erika F. Augustine
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Karthik Dinesh
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, USA
| | | | - Alistair M. Glidden
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - Stella Jensen-Roberts
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - Zachary Kabelac
- Department of Computer Science and Artificial Intelligence, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Dina Katabi
- Department of Computer Science and Artificial Intelligence, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Karl Kieburtz
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Daniel R. Kinel
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Max A. Little
- School of Computer Science, University of Birmingham, UK
- Massachusetts Institute of Technology, MA, USA
| | - Karlo J. Lizarraga
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Taylor Myers
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - Sara Riggare
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | | | - Suchi Saria
- Machine Learning, AI and Healthcare Lab, Johns Hopkins University, Baltimore, MD, USA
- Department of Computer Science, Statistics, and Health Policy, Johns Hopkins University, MD, USA
| | - Giovanni Schifitto
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Ruth B. Schneider
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Gaurav Sharma
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, USA
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, USA
| | - Ira Shoulson
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
- Grey Matter Technologies, Sarasota, FL, USA
| | - E. Anna Stevenson
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - Christopher G. Tarolli
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Jiebo Luo
- Department of Computer Science, University of Rochester, Rochester, NY, USA
| | - Michael P. McDermott
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, USA
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37
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Venkataraman K, Tai BC, Khoo EYH, Tavintharan S, Chandran K, Hwang SW, Phua MSLA, Wee HL, Koh GCH, Tai ES. Short-term strength and balance training does not improve quality of life but improves functional status in individuals with diabetic peripheral neuropathy: a randomised controlled trial. Diabetologia 2019; 62:2200-2210. [PMID: 31468106 PMCID: PMC6861346 DOI: 10.1007/s00125-019-04979-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 07/15/2019] [Indexed: 11/26/2022]
Abstract
AIMS/HYPOTHESIS The aim of this study was to test the effectiveness of a structured strength and balance training intervention in improving health-related quality of life (HRQoL) and functional status in individuals with diabetic peripheral neuropathy (DPN). METHODS The study was a single-blind parallel-group randomised controlled trial comparing 2 months of once-weekly home-based strength and balance training against standard medical therapy. Participants were patients with physician-diagnosed type 2 diabetes and neuropathy recruited from five public sector institutions in Singapore between July 2014 and October 2017. Participants were block-randomised to intervention or control arms. Outcomes were assessed at baseline, 2 months and 6 months by a trained assessor blinded to group assignment. Primary outcomes were change in physical component summary (PCS) score of SF-36v2 (a 36-item generic HRQoL instrument that has been validated for use in Singapore) and EQ-5D-5L index score (derived from a five-item generic HRQoL instrument [EQ-5D-5L]) over 6 months. Secondary outcomes were change in functional status (timed up-and-go [TUG], five times sit-to-stand [FTSTS], functional reach, static balance, ankle muscle strength and knee range of motion) and balance confidence over 6 months. Mean differences in scores between groups were compared using mixed models. RESULTS Of the 143 participants randomised (intervention, n = 70; control, n = 73), 67 participants were included in each arm for the final intention-to-treat analysis. The two groups were similar, except in terms of sex. There were no significant differences between groups on the primary outcomes of PCS score (mean difference [MD] 1.56 [95% CI -1.75, 4.87]; p = 0.355) and EQ-5D-5L index score (MD 0.02 [95% CI -0.01, 0.06]; p = 0.175). There were significant improvements in TUG test performance (MD -1.14 [95% CI -2.18, -0.1] s; p = 0.032), FTSTS test performance (MD -1.31 [95% CI -2.12, -0.51] s; p = 0.001), ankle muscle strength (MD 4.18 [95% CI 0.4, 7.92] N; p = 0.031), knee range of motion (MD 6.82 [95% CI 2.87, 10.78]°; p = 0.001) and balance confidence score (MD 6.17 [95% CI 1.89, 10.44]; p = 0.005). No adverse events due to study participation or study intervention were reported. CONCLUSIONS/INTERPRETATION Short-term structured strength and balance training did not influence HRQoL but produced sustained improvements in functional status and balance confidence at 6 months. More intensive interventions may be needed to influence HRQoL in these individuals. However, this intervention may be a useful treatment option for individuals with DPN to reduce the risk of falls and injuries. TRIAL REGISTRATION ClinicalTrials.gov NCT02115932 FUNDING: This work was supported by the National Medical Research Council, Singapore.
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Affiliation(s)
- Kavita Venkataraman
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building (MD1), 12 Science Drive 2, Singapore, 117549, Republic of Singapore.
| | - Bee Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building (MD1), 12 Science Drive 2, Singapore, 117549, Republic of Singapore
| | - Eric Y H Khoo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Republic of Singapore
| | | | - Kurumbian Chandran
- Department of Medicine, Ng Teng Fong General Hospital, Singapore, Republic of Singapore
| | - Siew Wai Hwang
- SingHealth Polyclinics-Bukit Merah, Singapore, Republic of Singapore
| | - Melissa S L A Phua
- Allied Health Services and Pharmacy, Foot Care and Limb Design Centre, Podiatry Service, Tan Tock Seng Hospital, Singapore, Republic of Singapore
| | - Hwee Lin Wee
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building (MD1), 12 Science Drive 2, Singapore, 117549, Republic of Singapore
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Republic of Singapore
| | - Gerald C H Koh
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building (MD1), 12 Science Drive 2, Singapore, 117549, Republic of Singapore
| | - E Shyong Tai
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Republic of Singapore
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38
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Godi M, Giardini M, Arcolin I, Ferrante S, Nardone A, Corna S, Colombo R. Is the Brief-BESTest Brief Enough? Suggested Modifications Based on Structural Validity and Internal Consistency. Phys Ther 2019; 99:1562-1573. [PMID: 31348513 DOI: 10.1093/ptj/pzz103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 02/01/2019] [Accepted: 02/21/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND The Brief Balance Evaluation Systems Test (Brief-BESTest) could be a useful tool for balance assessment. Although some psychometric characteristics have been examined, others still need to be clarified. OBJECTIVE The objective was to assess the structural validity, convergent validity, discriminant validity, and internal consistency of the Brief-BESTest in neurological patients. DESIGN This was a cross-sectional study. METHODS Data were from 416 patients with neurological disease and related balance disorders. Patients were assessed with the 5-levels Activities-Specific Balance Confidence Scale (ABC 5-levels), Brief-BESTest, and some simple balance tests (ie, 1-leg stance, Timed "Up & Go" test, functional reach, and a fall history questionnaire). Three Brief-BESTest models were examined through confirmatory factor analysis, and the following indexes were calculated: Comparative Fit Index, Tucker-Lewis Index, and root-mean-square error of approximation. Convergent validity was assessed by calculating the correlation between Brief-BESTest and ABC 5-levels total scores. Receiver operating characteristics assessed the ability of each model to differentiate between people with falls and those without falls. Internal consistency was measured with Cronbach α and coefficient ω. RESULTS Confirmatory factor analysis showed model 3 (Comparative Fit Index = 0.97; Tucker-Lewis Index = 0.95; root-mean-square error of approximation = 0.05), with item 1 removed and error covariance between items 3 and 4 and between items 5 and 6, to have a significantly better structure than models 1 and 2. The correlation between Brief-BESTest and ABC 5-levels was 0.61 (Spearman ρ) for all 3 models. The area under the curve of the receiver operating characteristics showed an acceptable accuracy (0.72) in distinguishing patients with a history of falls from those without a history of falls (95% confidence interval = 0.66-0.78) for all models and was superior to the areas under the curve of other simple balance tests (1-leg stance, Timed "Up & Go" test, functional reach). Cronbach α was good for Brief-BESTest models 1 (0.92) and 3 (0.92), but ω was greater than 0.80 only for model 3. LIMITATIONS The sample was heterogeneous. CONCLUSIONS The Brief-BESTest, after some changes, shows good validity and internal consistency in patients affected by different balance disorders.
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Affiliation(s)
- Marco Godi
- Division of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno, Italy
| | - Marica Giardini
- Division of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno, Italy
| | - Ilaria Arcolin
- Division of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno, Italy
| | - Simona Ferrante
- Department of Electronics, Information and Bioengineering, Neuroengineering and Medical Robotics Laboratory, Politecnico di Milano, Milan, Italy
| | - Antonio Nardone
- Division of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Stefano Corna
- Division of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno, Italy
| | - Roberto Colombo
- Division of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno, Italy
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Mancini M, Curtze C, Stuart S, El-Gohary M, Nutt JG, Horak FB. The Impact Of Freezing Of Gait On Balance Perception And Mobility In Community-Living With Parkinson'S Disease. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2019; 2018:3040-3043. [PMID: 30441036 DOI: 10.1109/embc.2018.8512910] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This pilot study investigated the impact of freezing of gait, objectively measured with three inertial sensors, on mobility function during seven days of communityliving monitoring in people with Parkinson's disease.Twenty-four subjects with PD, of which 14 experiencing freezing of gait, were recruited in this study. Subjects wore three inertial sensors (Opals, APDM) attached to both feet and the lumbar region for a week of continuous monitoring. Walking bouts, of at least 10s, were first identified, and then features of freezing, quantity and quality of mobility were extracted and averaged across the seven days.Results showed significant impairments in freezing and quality of mobility in the freezers group compared to the nonfreezers. Our measures of average and variability of time spent freezing was associated to the subjects' perception of freezing, assessed with the New Freezing of Gait Questionnaire. These preliminary results are introducing promising measures of mobility impairments measured during community-living in PD.
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Ghislieri M, Gastaldi L, Pastorelli S, Tadano S, Agostini V. Wearable Inertial Sensors to Assess Standing Balance: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2019; 19:E4075. [PMID: 31547181 PMCID: PMC6806601 DOI: 10.3390/s19194075] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/12/2019] [Accepted: 09/17/2019] [Indexed: 02/06/2023]
Abstract
Wearable sensors are de facto revolutionizing the assessment of standing balance. The aim of this work is to review the state-of-the-art literature that adopts this new posturographic paradigm, i.e., to analyse human postural sway through inertial sensors directly worn on the subject body. After a systematic search on PubMed and Scopus databases, two raters evaluated the quality of 73 full-text articles, selecting 47 high-quality contributions. A good inter-rater reliability was obtained (Cohen's kappa = 0.79). This selection of papers was used to summarize the available knowledge on the types of sensors used and their positioning, the data acquisition protocols and the main applications in this field (e.g., "active aging", biofeedback-based rehabilitation for fall prevention, and the management of Parkinson's disease and other balance-related pathologies), as well as the most adopted outcome measures. A critical discussion on the validation of wearable systems against gold standards is also presented.
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Affiliation(s)
- Marco Ghislieri
- Department of Electronics and Telecommunications, Politecnico di Torino, 10129 Torino, Italy.
| | - Laura Gastaldi
- Department of Mathematical Sciences, Politecnico di Torino, 10129 Torino, Italy.
| | - Stefano Pastorelli
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, 10129 Torino, Italy.
| | - Shigeru Tadano
- National Institute of Technology, Hakodate College, Hakodatate 042-8501, Japan.
- Division of Human Mechanical Systems and Design, Faculty of Engineering, Hokkaido University, Sapporo 060-0808, Japan.
| | - Valentina Agostini
- Department of Electronics and Telecommunications, Politecnico di Torino, 10129 Torino, Italy.
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41
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Hasegawa N, Shah VV, Carlson-Kuhta P, Nutt JG, Horak FB, Mancini M. How to Select Balance Measures Sensitive to Parkinson's Disease from Body-Worn Inertial Sensors-Separating the Trees from the Forest. SENSORS 2019; 19:s19153320. [PMID: 31357742 PMCID: PMC6696209 DOI: 10.3390/s19153320] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/24/2019] [Accepted: 07/25/2019] [Indexed: 11/16/2022]
Abstract
This study aimed to determine the most sensitive objective measures of balance dysfunction that differ between people with Parkinson’s Disease (PD) and healthy controls. One-hundred and forty-four people with PD and 79 age-matched healthy controls wore eight inertial sensors while performing tasks to measure five domains of balance: standing posture (Sway), anticipatory postural adjustments (APAs), automatic postural responses (APRs), dynamic posture (Gait) and limits of stability (LOS). To reduce the initial 93 measures, we selected uncorrelated measures that were most sensitive to PD. After applying a threshold on the Standardized Mean Difference between PD and healthy controls, 44 measures remained; and after reducing highly correlated measures, 24 measures remained. The four most sensitive measures were from APAs and Gait domains. The random forest with 10-fold cross-validation on the remaining measures (n = 24) showed an accuracy to separate PD from healthy controls of 82.4%—identical to result for all measures. Measures from the most sensitive domains, APAs and Gait, were significantly correlated with the severity of disease and with patient-related outcomes. This method greatly reduced the objective measures of balance to the most sensitive for PD, while still capturing four of the five domains of balance.
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Affiliation(s)
- Naoya Hasegawa
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239-3098, USA
| | - Vrutangkumar V Shah
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239-3098, USA
| | - Patricia Carlson-Kuhta
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239-3098, USA
| | - John G Nutt
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239-3098, USA
| | - Fay B Horak
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239-3098, USA
| | - Martina Mancini
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239-3098, USA.
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Brognara L, Palumbo P, Grimm B, Palmerini L. Assessing Gait in Parkinson's Disease Using Wearable Motion Sensors: A Systematic Review. Diseases 2019; 7:diseases7010018. [PMID: 30764502 PMCID: PMC6473911 DOI: 10.3390/diseases7010018] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/31/2019] [Accepted: 02/01/2019] [Indexed: 01/26/2023] Open
Abstract
Abstract: Parkinson’s disease (PD) is a progressive neurodegenerative disorder. Gait impairments are common among people with PD. Wearable sensor systems can be used for gait analysis by providing spatio-temporal parameters useful to investigate the progression of gait problems in Parkinson disease. However, various methods and tools with very high variability have been developed. The aim of this study is to review published articles of the last 10 years (from 2008 to 2018) concerning the application of wearable sensors to assess spatio-temporal parameters of gait in patients with PD. We focus on inertial sensors used for gait analysis in the clinical environment (i.e., we do not cover the use of inertial sensors to monitor walking or general activities at home, in unsupervised environments). Materials and Methods: Relevant articles were searched in the Medline database using Pubmed. Results and Discussion: Two hundred ninety-four articles were initially identified while searching the scientific literature regarding this topic. Thirty-six articles were selected and included in this review. Conclusion: Wearable motion sensors are useful, non-invasive, low-cost, and objective tools that are being extensively used to perform gait analysis on PD patients. Being able to diagnose and monitor the progression of PD patients makes wearable sensors very useful to evaluate clinical efficacy before and after therapeutic interventions. However, there is no uniformity in the use of wearable sensors in terms of: number of sensors, positioning, chosen parameters, and other characteristics. Future research should focus on standardizing the measurement setup and selecting which spatio-temporal parameters are the most informative to analyze gait in PD. These parameters should be provided as standard assessments in all studies to increase replicability and comparability of results.
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Affiliation(s)
- Lorenzo Brognara
- Department of Biomedical and Neuromotor Science, University of Bologna, Via Ugo Foscolo 7, 40123 Bologna, Italy.
| | - Pierpaolo Palumbo
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Viale Risorgimento 2, 40136 Bologna, Italy.
| | - Bernd Grimm
- Sylvia Lawry Centre - The Human Motion Institute, 81677 Munich, Germany.
| | - Luca Palmerini
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Viale Risorgimento 2, 40136 Bologna, Italy.
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Leavy B, Löfgren N, Nilsson M, Franzén E. Patient-reported and performance-based measures of walking in mild-moderate Parkinson's disease. Brain Behav 2018; 8:e01081. [PMID: 30136397 PMCID: PMC6160642 DOI: 10.1002/brb3.1081] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 06/25/2018] [Accepted: 06/30/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Knowledge of the relationships between patient-reported and performance-based walking measures in Parkinson's disease (PD) should inform clinical decision-making. The Walk-12G reliably captures perceived walking difficulties but has not been compared to performance-based walking in laboratory or free-living settings or across different groups. OBJECTIVES To investigate the relationship between patient-reported walking difficulties (Walk-12G) and performance-based walking in laboratory and free-living conditions and to determine whether the Walk-12G can distinguish between the subgroups, (i) people with/without PD and (ii) mild/moderate disease stages. METHODS Forty-seven people without and 49 people with PD (Hoehn and Yahr stage II and III) were assessed in relation to patient-reported walking difficulties (Walk-12G scale); spatiotemporal gait characteristics (Pace; Rhythm; Asymmetry; Variability; and Postural control) using a laboratory-based electronic walkway; and walking behavior (mean steps/day and minutes of brisk walking/day) using accelerometers in free-living conditions. RESULTS The Walk-12G correlated moderately with the spatiotemporal domain step velocity (r = -0.46) and walking behavior, measured as mean steps/day (r = -0.46). Weaker correlations were observed for step length and minutes spent in brisk walking (r = -0.36 and r = -0.35, respectively). Poor correlations were observed for all other spatiotemporal domains. The Walk-12G could distinguish between people with and without PD (Effect size, r = 0.82) and between those at mild/moderate disease stages (r = 0.34). CONCLUSIONS Perceived walking difficulties showed weak to moderate associations with performance-based measures of walking in mild-moderate PD. As the strongest associations were observed for step velocity and walking behavior, targeting these specific gait aspects could improve perceived walking difficulties in daily life.
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Affiliation(s)
- Breiffni Leavy
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden.,Stockholms Sjukhem Foundation, Stockholm, Sweden
| | - Niklas Löfgren
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden.,Function Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Nilsson
- Department of Health Sciences, Lund University, Lund, Sweden.,Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Erika Franzén
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden.,Function Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
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Silva KG, De Freitas TB, Doná F, Ganança FF, Ferraz HB, Torriani-Pasin C, Pompeu JE. Effects of virtual rehabilitation versus conventional physical therapy on postural control, gait, and cognition of patients with Parkinson's disease: study protocol for a randomized controlled feasibility trial. Pilot Feasibility Stud 2017; 3:68. [PMID: 29225912 PMCID: PMC5719545 DOI: 10.1186/s40814-017-0210-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 11/16/2017] [Indexed: 11/30/2022] Open
Abstract
Background There is an association among postural instability, gait dysfunction, and cognitive impairment in subjects with Parkinson’s disease (PD). Difficulty in dividing attention, response inhibition, and visuospatial attention deficiencies may contribute to the impairment of motor performance during daily activities. There are strong evidences that physical therapy can prevent physical and cognitive decline in individuals with PD. Recently, the European Physiotherapy Guideline (EPG) was developed based on randomized clinical trials about the effectiveness of the physical therapy to improve the functional deficiencies of individuals with PD. The EPG did not include the use of promising new intervention as virtual reality in PD due the lack of studies about its safety, feasibility and effectiveness. Therefore, this study protocol had as objective to evaluate the feasibility, safety and effectiveness of a physical therapy program-based on the European Physiotherapy Guideline (EPG) compared to Kinect-based training on postural control, gait, cognition, and quality of life (QoL) of Individuals with PD. Methods/design A single-blind, parallel, randomized, controlled feasibility trial will be conducted with a sample of 32 individuals diagnosed with idiopathic PD. Participants will be allocated into control group (CG) and experimental group (EG). The intervention of the CG will be conventional physical therapy, and the intervention of the EG will be a supervised practice of five Kinect games. Both groups will perform 14 sessions of 1 h each one, twice a week over 7 weeks. Process outcomes will be safety, feasibility, adherence, and acceptability. Safety will be assessed by the proportion of participants who experienced intervention-related adverse events or any serious adverse event during the study period. Feasibility will be assessed through the scores of the games recorded in all training sessions. Adherence will be assessed through the participant’s attendance. Acceptability will be the motivation of the participants regarding the interventions. Clinical outcomes will be (1) postural control, (2) cognitive function, (3) balance, (4) gait, and (5) QoL. Individuals will be assessed pre- and post-interventions and after 30 days by a blinded evaluator. Discussion This protocol will clarify if an intervention based on Kinect games will be feasible, safe, and acceptable for individuals with PD compared to conventional physical therapy. We will verify whether the proposed interventions can improve clinical outcomes as postural control, gait, cognition, and QoL of individuals with PD. Our hypothesis is that both Kinect games and conventional physical therapy will be feasible, safe, and acceptable for individuals with PD and will promote positive clinical effects. The results of this feasibility study will be used to design a future definitive clinical trial. Trial registration Unique identification number in WHO Trial Registration: U1111-1171-0371. Brazilian Clinical Trial Registration Number RBR-27kqv5, registration date: February, 2016. Electronic supplementary material The online version of this article (10.1186/s40814-017-0210-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Keyte Guedes Silva
- Department of Neuroscience and Behavior, Institute of Psychology, University of São Paulo, 1721 Professor Mello de Morais Avenue, Cidade Universitária, São Paulo, SP 05508-030 Brazil
| | - Tatiana Beline De Freitas
- Motor Behavior Laboratory, School of Physical Education and Sports, University of São Paulo, 65 Professor Mello Moraes Avenue, Cidade Universitária, São Paulo, SP 05508-030 Brazil
| | - Flávia Doná
- Anhanguera Educational, 3305 Raimundo Pereira de Magalhães Avenue, Pirituba, São Paulo, SP 05145-200 Brazil
| | - Fernando Freitas Ganança
- Department of Otorhinolaryngology and Head and Neck Surgery, Federal University of São Paulo, 947 Pedro de Toledo Street, Vila Clementino, São Paulo, SP 04039-002 Brazil
| | - Henrique Ballalai Ferraz
- Department of Neurology, Federal University of São Paulo, 650 Pedro de Toledo Street, Vila Clementino, São Paulo, SP 04039-002 Brazil
| | - Camila Torriani-Pasin
- Motor Behavior Laboratory, School of Physical Education and Sports, University of São Paulo, 65 Professor Mello Moraes Avenue, Cidade Universitária, São Paulo, SP 05508-030 Brazil
| | - José Eduardo Pompeu
- Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine, University of São Paulo, 51 Cipotânea Street, Cidade Universitária, São Paulo, SP 05360-000 Brazil
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Impact of Mézières Rehabilitative Method in Patients with Parkinson's Disease: A Randomized Controlled Trial. PARKINSONS DISEASE 2017; 2017:2762987. [PMID: 29333316 PMCID: PMC5733228 DOI: 10.1155/2017/2762987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 10/08/2017] [Indexed: 01/22/2023]
Abstract
The aim of this study was to assess the efficacy of Mézières method in improving trunk flexibility of the back muscles and balance in patients with Parkinson's disease (PD). Materials and Methods. Thirty-six patients were randomized into 2 groups: the Mézières treatment group and the control group (home exercise group). The primary outcome was the improvement in balance per the Berg Balance Scale (BBS) and the trunk flexibility of the back for the anterior flexion trunk test. Also, we evaluated pain, gait balance for the Functional Gait Assessment (FGA), disease-related disability for the Modified Parkinson's Activity Scale and the Unified Parkinson's Disease Rating Scale (UPDRS), the quality of life, and the functional exercise capacity. All the measures were evaluated at baseline (T0), at the end of the rehabilitative program (T1), and at the 12-week follow-up (T2). Results. In the Mézières group, the BBS (p < .001) and trunk flexion test (p < .001) improved significantly at T1 and remained the same at T2. Between groups, significant changes were reported in FGA (p = .027) and UPDRS Total (p = .007) at T1 and in FGA (p = .03) at T2. Conclusion. The Mézières approach is efficacious in improving the flexibility of the trunk and balance in PD patients.
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Dopaminergic and non-dopaminergic gait components assessed by instrumented timed up and go test in Parkinson’s disease. J Neural Transm (Vienna) 2017; 124:1539-1546. [DOI: 10.1007/s00702-017-1794-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 10/03/2017] [Indexed: 10/18/2022]
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Rovini E, Maremmani C, Cavallo F. How Wearable Sensors Can Support Parkinson's Disease Diagnosis and Treatment: A Systematic Review. Front Neurosci 2017; 11:555. [PMID: 29056899 PMCID: PMC5635326 DOI: 10.3389/fnins.2017.00555] [Citation(s) in RCA: 192] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 09/21/2017] [Indexed: 01/15/2023] Open
Abstract
Background: Parkinson's disease (PD) is a common and disabling pathology that is characterized by both motor and non-motor symptoms and affects millions of people worldwide. The disease significantly affects quality of life of those affected. Many works in literature discuss the effects of the disease. The most promising trends involve sensor devices, which are low cost, low power, unobtrusive, and accurate in the measurements, for monitoring and managing the pathology. OBJECTIVES This review focuses on wearable devices for PD applications and identifies five main fields: early diagnosis, tremor, body motion analysis, motor fluctuations (ON-OFF phases), and home and long-term monitoring. The concept is to obtain an overview of the pathology at each stage of development, from the beginning of the disease to consider early symptoms, during disease progression with analysis of the most common disorders, and including management of the most complicated situations (i.e., motor fluctuations and long-term remote monitoring). DATA SOURCES The research was conducted within three databases: IEEE Xplore®, Science Direct®, and PubMed Central®, between January 2006 and December 2016. STUDY ELIGIBILITY CRITERIA Since 1,429 articles were found, accurate definition of the exclusion criteria and selection strategy allowed identification of the most relevant papers. RESULTS Finally, 136 papers were fully evaluated and included in this review, allowing a wide overview of wearable devices for the management of Parkinson's disease.
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Affiliation(s)
- Erika Rovini
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy
| | - Carlo Maremmani
- U.O. Neurologia, Ospedale delle Apuane (AUSL Toscana Nord Ovest), Massa, Italy
| | - Filippo Cavallo
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy
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Pal G, O'Keefe J, Robertson-Dick E, Bernard B, Anderson S, Hall D. Global cognitive function and processing speed are associated with gait and balance dysfunction in Parkinson's disease. J Neuroeng Rehabil 2016; 13:94. [PMID: 27793167 PMCID: PMC5084375 DOI: 10.1186/s12984-016-0205-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 10/25/2016] [Indexed: 12/25/2022] Open
Abstract
Background Our primary objective was to determine the relationship between global cognitive function and specific domains of gait and balance in a cohort of Parkinson’s disease (PD) subjects. In a secondary analysis, we determined whether specific cognitive domains correlated with gait and balance performance. Methods Fourteen PD subjects (mean age 61.1 ± 7.8 years) were recruited from the Rush University Medical Center Movement Disorders clinic. Subjects underwent clinical assessment using the motor subsection of the Unified Parkinson’s Disease Rating Scale (UPDRS) followed by quantitative gait and balance assessments using the APDM Mobility Lab™ system (Mobility Lab, APDM Inc., Portland, OR). Subjects completed global cognitive testing using the Mattis Dementia Rating Scale (MDRS) as well as domain specific cognitive measures. Spearman’s rho was used to assess correlations between cognitive measures and gait and balance function, with False Discovery Rate (FDR) correction for multiple comparisons. Results Global cognitive function had the strongest correlation with stride velocity (r = 0.816, p = 0.001), turn duration (r = −0.806, p = 0.001), number of steps to turn (r = −0.830, p = 0.001), and mean velocity of postural sway in the medio-lateral direction (r = −0.726, p = 0.005). A significant correlation was found between processing speed and two turning measures (turn duration, r = −0.884, p = 0.001; number of steps to turn, r = −0.954, p < 0.001), but no other associations were found between specific cognitive domains and gait domains. Conclusions This pilot study provides preliminary data regarding the association between global cognitive function and pace-related measures of gait, turning, and postural sway. Furthermore, reduced processing speed was found to be associated with difficulty in performing turns.
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Affiliation(s)
- Gian Pal
- Department of Neurological Sciences, Rush University, Chicago, IL, USA. .,Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Joan O'Keefe
- Department of Neurological Sciences, Rush University, Chicago, IL, USA.,Department of Anatomy and Cell Biology, Rush University, Chicago, IL, USA
| | | | - Bryan Bernard
- Department of Neurological Sciences, Rush University, Chicago, IL, USA
| | - Sharlet Anderson
- Department of Neurological Sciences, Rush University, Chicago, IL, USA
| | - Deborah Hall
- Department of Neurological Sciences, Rush University, Chicago, IL, USA
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