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Fortunati M, Febbi M, Negro M, Gennaro F, D’Antona G, Crisafulli O. Lower-Limb Exoskeletons for Gait Training in Parkinson's Disease: The State of the Art and Future Perspectives. Healthcare (Basel) 2024; 12:1636. [PMID: 39201194 PMCID: PMC11353983 DOI: 10.3390/healthcare12161636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 08/07/2024] [Accepted: 08/14/2024] [Indexed: 09/02/2024] Open
Abstract
Gait dysfunction (GD) is a common impairment of Parkinson's disease (PD), which negatively impacts patients' quality of life. Among the most recent rehabilitation technologies, a lower-limb powered exoskeleton (LLEXO) arises as a useful instrument for gait training in several neurological conditions, including PD. However, some questions relating to methods of use, achievable results, and usefulness compared to traditional rehabilitation methodologies still require clear answers. Therefore, in this review, we aim to summarise and analyse all the studies that have applied an LLEXO to train gait in PD patients. Literature research on PubMed and Scopus retrieved five articles, comprising 46 PD participants stable on medications (age: 71.7 ± 3.7 years, 24 males, Hoehn and Yahr: 2.1 ± 0.6). Compared to traditional rehabilitation, low-profile lower-limb exoskeleton (lp-LLEXO) training brought major improvements towards walking capacity and gait speed, while there are no clear major benefits regarding the dual-task gait cost index and freezing of gait symptoms. Importantly, the results suggest that lp-LLEXO training is more beneficial for patients with an intermediate-to-severe level of disease severity (Hoehn and Yahr > 2.5). This review could provide a novel framework for implementing LLEXO in clinical practise, highlighting its benefits and limitations towards gait training.
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Affiliation(s)
- Matteo Fortunati
- Department of Industrial Engineering, University of Tor Vergata, 00133 Rome, Italy
- CRIAMS-Sport Medicine Centre Voghera, University of Pavia, 27058 Voghera, Italy
| | - Massimiliano Febbi
- Department of Industrial Engineering, University of Tor Vergata, 00133 Rome, Italy
- Laboratory for Rehabilitation, Medicine and Sport (LARM), 00133 Rome, Italy
| | - Massimo Negro
- CRIAMS-Sport Medicine Centre Voghera, University of Pavia, 27058 Voghera, Italy
| | - Federico Gennaro
- Department of Biomedical Sciences, University of Padua, 35131 Padua, Italy
| | - Giuseppe D’Antona
- CRIAMS-Sport Medicine Centre Voghera, University of Pavia, 27058 Voghera, Italy
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Oscar Crisafulli
- CRIAMS-Sport Medicine Centre Voghera, University of Pavia, 27058 Voghera, Italy
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Sawai S, Murata S, Sakano Y, Fujikawa S, Yamamoto R, Shizuka Y, Nakano H. Dominance of attentional focus: a comparative study on its impact on standing postural control in healthy younger and older adults. Front Hum Neurosci 2024; 18:1384305. [PMID: 38988825 PMCID: PMC11233467 DOI: 10.3389/fnhum.2024.1384305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 06/11/2024] [Indexed: 07/12/2024] Open
Abstract
Introduction Attentional focus is a phenomenon in which shifting the focus of attention alters performance of standing postural control. It can be categorized as internal focus (IF), which directs attention to the body parts, or external focus (EF), which directs attention to the external environment. Although attentional focus that improves standing postural control in younger people exhibits individual dominance, the dominance of attentional focus in standing postural control in older adults remains ambiguous. Therefore, this study aimed to compare the dominance of attentional focus in standing postural control between healthy younger and older adults, a crucial step for understanding the aging process. Methods The participants performed a standing postural control task under the IF and EF conditions. Based on the condition during which they exhibited superior performance, the participants were divided into two groups: IF-dominant and EF-dominant. The standing postural control performance in each group under the IF and EF conditions was subsequently compared. Results The results showed that the participants, encompassing both younger and older adults, were divided into the IF-dominant and EF-dominant groups, confirming the dominance of attentional focus. The performance under the EF condition in older adults was also influenced by the dominance of attentional focus. Conclusion These results highlight the potential importance of intervention methods based on the dominance of attentional focus, providing valuable insights into future research and clinical practice.
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Affiliation(s)
- Shun Sawai
- Graduate School of Health Sciences, Kyoto Tachibana University, Kyoto, Japan
- Department of Rehabilitation, Kyoto Kuno Hospital, Kyoto, Japan
| | - Shin Murata
- Graduate School of Health Sciences, Kyoto Tachibana University, Kyoto, Japan
- Department of Physical Therapy, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto, Japan
| | - Yuya Sakano
- Graduate School of Health Sciences, Kyoto Tachibana University, Kyoto, Japan
- Kissho-Home of Social Welfare Corporation Seiwaen, Kyoto, Japan
| | - Shoya Fujikawa
- Graduate School of Health Sciences, Kyoto Tachibana University, Kyoto, Japan
- Department of Physical Therapy, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto, Japan
| | - Ryosuke Yamamoto
- Graduate School of Health Sciences, Kyoto Tachibana University, Kyoto, Japan
- Department of Rehabilitation, Tesseikai Neurosurgical Hospital, Shijonawate, Japan
| | - Yusuke Shizuka
- Department of Physical Therapy, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto, Japan
| | - Hideki Nakano
- Graduate School of Health Sciences, Kyoto Tachibana University, Kyoto, Japan
- Department of Physical Therapy, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto, Japan
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Mezzarobba S, Grassi M, Galliussi J, Murena L, Bernardis P. Perception of biological motion. No sensitivity differences between patients with Parkinson's disease and healthy observers. APPLIED NEUROPSYCHOLOGY. ADULT 2023; 30:63-70. [PMID: 33886377 DOI: 10.1080/23279095.2021.1910511] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The use of biological motion (BM) stimuli (point-light walkers PLW) may be a novel alternative to improve the clinical impact of Action Observation treatments in Parkinson's Disease, by directing the patient's attentional focus on gait kinematics. However, the recognition of biological motion in Parkinson's patients has thus far been controversial. To evaluate the clinical feasibility of using BM stimuli in Action Observation treatments, we aimed at investigating whether Parkinson's patients in the ON-state condition can identify and use gender-specific cues conveyed by the body structure and by the kinematics of gait of a PLW. 30 Parkinson's patients and 30 healthy elderly observers were tested in a gender identification task with PLW. Parkinson's patients were able to correctly identify the gender of PLW; no differences were found between the two groups of observers. While for both groups, the gender identification task was easier when it required a judgment on a healthy PLW. Lastly, we found that females were more sensitive than males in our identification task. Our study shows that Parkinson's patients in the ON-state condition are able to extract subtle structural and kinematic characteristics from biological motion stimuli, which is favorable to the use of BM in Action Observation treatments.
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Affiliation(s)
- Susanna Mezzarobba
- Department of Life Sciences, University of Trieste, Trieste, Italy.,Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy.,Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Michele Grassi
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | | | - Luigi Murena
- Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy.,Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Paolo Bernardis
- Department of Life Sciences, University of Trieste, Trieste, Italy
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Motor Resonance Flexibility to Emotion-Enriched Context in Parkinson's Disease Patients. Behav Neurol 2022; 2022:6487419. [PMID: 36755906 PMCID: PMC9900249 DOI: 10.1155/2022/6487419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/05/2022] [Accepted: 12/08/2022] [Indexed: 12/31/2022] Open
Abstract
In healthy people, motor resonance mechanisms are flexible to negative emotional contextual clues with greater motor resonance during the observation of a reach to grasp movement performed in an environment eliciting disgust. The link between emotion and motor control has become an interesting topic in Parkinson's disease (PD). Here, we aimed to study the response of the mirror neuron system, specifically motor resonance, to an emotion-enriched context in people with PD. Corticospinal excitability was recorded in a total of 44 participants, divided into two groups (23 PD patients and 21 healthy subjects). We recorded motor-evoked potentials from a muscle involved in the grasping movement while participants were watching the same reach-to-grasp movement embedded in surrounds with negative emotional valence, but different levels of arousal: sadness (low arousal) and disgust (high arousal). Basic motor resonance mechanisms were less efficient in PD than controls. Responsiveness to emotional contextual clues eliciting sadness was similar between PD and controls, whereas responsiveness to emotional contextual clues eliciting disgust was impaired in PD patients. Our findings show reduced motor resonance flexibility to the disgusting context, supporting the hypothesis that PD patients may have a deficit in "translating" an aversive motivational state into a physiologic response. The amygdala, which is implicated in the appraisal of fearful stimuli and response to threatening situations, might be implicated in this process.
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Visibly constraining an agent modulates observers' automatic false-belief tracking. Sci Rep 2020; 10:11311. [PMID: 32647240 PMCID: PMC7347931 DOI: 10.1038/s41598-020-68240-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/17/2020] [Indexed: 12/14/2022] Open
Abstract
Our motor system can generate representations which carry information about the goals of another agent’s actions. However, it is not known whether motor representations play a deeper role in social understanding, and, in particular, whether they enable tracking others’ beliefs. Here we show that, for adult observers, reliably manifesting an ability to track another’s false belief critically depends on representing the agent’s potential actions motorically. One signature of motor representations is that they can be disrupted by constraints on an observed agent’s action capacities. We therefore used a ‘mummification’ technique to manipulate whether the agent in a visual ball-detection task was free to act or whether he was visibly constrained from acting. Adults’ reaction times reliably reflected the agent’s beliefs only when the agent was free to act on the ball and not when the agent was visibly constrained from acting. Furthermore, it was the agent’s constrained action capabilities, rather than any perceptual novelty, that determined whether adult observers’ reaction times reliably reflected the agent’s beliefs. These findings signal that our motor system may underpin more of social cognition than previously imagined, and, in particular, that motor representations may underpin automatic false-belief tracking.
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Farina E, Borgnis F, Pozzo T. Mirror neurons and their relationship with neurodegenerative disorders. J Neurosci Res 2020; 98:1070-1094. [DOI: 10.1002/jnr.24579] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 12/12/2022]
Affiliation(s)
| | | | - Thierry Pozzo
- INSERM UMR1093‐CAPS, Université Bourgogne Franche‐Comté Dijon France
- IT@UniFe Center for Translational Neurophysiology Istituto Italiano di Tecnologia Ferrara Italy
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Krzysztoń K, Stolarski J, Kochanowski J. Evaluation of Balance Disorders in Parkinson's Disease Using Simple Diagnostic Tests-Not So Simple to Choose. Front Neurol 2018; 9:932. [PMID: 30429825 PMCID: PMC6220048 DOI: 10.3389/fneur.2018.00932] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 10/15/2018] [Indexed: 11/15/2022] Open
Abstract
Background: Balance disorders are one of the main symptoms in parkinson's Disease (PD)—patients have a tendency to fall, related traumas and also a significant restriction of mobility. Numerous tools may be used to evaluate the balance, but it is difficult to choose the proper one. The aim of this review was to compare simple diagnostic tools for PD and emphasize those characterized by a high reliability and sensitivity. Methods: The global literature search was conducted in PubMED, Scopus, Science Direct, Web of Science, Cochrane, and Google Scholar for publications in English and Polish. Results: According to the literature some scales and functional tests in which clinimetric properties had been assessed in PD population were selected and described. Conclusion: Basing on current knowledge, psychometric properties, and clinical experience, the authors suggest the BESTest with its shortened versions and the Fullerton Advanced Balance Scale to be used for comprehensive balance assessment of parkinson's disease patients. These tests are easy in administration, not time-consuming and provide a professional diagnosis allowing to plan individual therapy for the patient being examined.
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Affiliation(s)
- Karolina Krzysztoń
- Department of Neurology of the Second Faculty of Medicine with the English Division and the Physiotherapy Division, Medical University of Warsaw, Warsaw, Poland
| | - Jakub Stolarski
- Department of Neurology of the Second Faculty of Medicine with the English Division and the Physiotherapy Division, Medical University of Warsaw, Warsaw, Poland
| | - Jan Kochanowski
- Department of Neurology of the Second Faculty of Medicine with the English Division and the Physiotherapy Division, Medical University of Warsaw, Warsaw, Poland
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