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Muñoz-Mata BG, Dorantes-Méndez G, Piña-Ramírez O. Classification of Parkinson's disease severity using gait stance signals in a spatiotemporal deep learning classifier. Med Biol Eng Comput 2024:10.1007/s11517-024-03148-2. [PMID: 38884852 DOI: 10.1007/s11517-024-03148-2] [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: 02/14/2023] [Accepted: 06/03/2024] [Indexed: 06/18/2024]
Abstract
Parkinson's disease (PD) is a degenerative nervous system disorder involving motor disturbances. Motor alterations affect the gait according to the progression of PD and can be used by experts in movement disorders to rate the severity of the disease. However, this rating depends on the expertise of the clinical specialist. Therefore, the diagnosis may be inaccurate, particularly in the early stages of PD where abnormal gait patterns can result from normal aging or other medical conditions. Consequently, several classification systems have been developed to enhance PD diagnosis. In this paper, a PD gait severity classification algorithm was developed using vertical ground reaction force (VGRF) signals. The VGRF records used are from a public database that includes 93 PD patients and 72 healthy controls adults. The work presented here focuses on modeling each foot's gait stance phase signals using a modified convolutional long deep neural network (CLDNN) architecture. Subsequently, the results of each model are combined to predict PD severity. The classifier performance was evaluated using ten-fold cross-validation. The best-weighted accuracies obtained were 99.296(0.128)% and 99.343(0.182)%, with the Hoehn-Yahr and UPDRS scales, respectively, outperforming previous results presented in the literature. The classifier proposed here can effectively differentiate gait patterns of different PD severity levels based on gait signals of the stance phase.
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Affiliation(s)
- Brenda G Muñoz-Mata
- Facultad de Ciencias, Universidad Autónoma de San Luis Potosí, Av. Parque Chapultepec 1570, San Luis Potosí, 78295, San Luis Potosí, México
| | - Guadalupe Dorantes-Méndez
- Facultad de Ciencias, Universidad Autónoma de San Luis Potosí, Av. Parque Chapultepec 1570, San Luis Potosí, 78295, San Luis Potosí, México.
| | - Omar Piña-Ramírez
- Departamento de Bioinformática y Análisis Estadísticos, Instituto Nacional de Perinatología "Isidro Espinosa de los Reyes", Montes Urales 800, Ciudad de México, 11000, Ciudad de México, México
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2
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Cen S, Zhang H, Li Y, Gu Z, Yuan Y, Ruan Z, Cai Y, Chhetri JK, Liu S, Mao W, Chan P. Gait Analysis with Wearable Sensors in Isolated REM Sleep Behavior Disorder Associated with Phenoconversion: An Explorative Study. JOURNAL OF PARKINSON'S DISEASE 2024:JPD230397. [PMID: 38848196 DOI: 10.3233/jpd-230397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
Background Gait disturbance is a vital characteristic of motor manifestation in α- synucleinopathies, especially Parkinson's disease. Subtle gait alterations are present in isolated rapid eye movement sleep behavior disorder (iRBD) patients before phenoconversion; it is yet unclear, if gait analysis may predict phenoconversion. Objective To investigate subtle gait alterations and explore whether gait analysis using wearable sensors is associated with phenoconversion of iRBD to α-synucleinopathies. Methods Thirty-one polysomnography-confirmed iRBD patients and 33 healthy controls (HCs) were enrolled at baseline. All participants walked for a minute while wearing 6 inertial sensors on bilateral wrists, ankles, and the trunk (sternal and lumbar region). Three conditions were tested: (i) normal walking, (ii) fast walking, and (iii) dual-task walking. Results Decreased arm range of motion and increased gait variation (stride length, stride time and stride velocity) discriminate converters from HCs at baseline. After an average of 5.40 years of follow-up, 10 patients converted to neurodegenerative diseases (converters). Cox regression analysis showed higher value of stride length asymmetry under normal walking condition to be associated with an early conversion of iRBD to α- synucleinopathies (adjusted HR 4.468, 95% CI 1.088- 18.349, p = 0.038). Conclusions Stride length asymmetry is associated with progression to α- synucleinopathies in patients with iRBD. Gait analysis with wearable sensors may be useful for screening, monitoring, and risk stratification for disease-modifying therapy trials in patients with iRBD.
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Affiliation(s)
- Shanshan Cen
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Hui Zhang
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
- Department of Neurobiology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Yuan Li
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
- Department of Neurobiology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Zhuqin Gu
- Department of Neurobiology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Yuan Yuan
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Zheng Ruan
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Yanning Cai
- Department of Neurobiology, Xuanwu Hospital of Capital Medical University, Beijing, China
- Key Laboratory for Neurodegenerative Diseases of the Ministry of Education, Beijing Key Laboratory on Parkinson's Disease, Parkinson's Disease Center for Beijing Institute on Brain Disorders, Clinical and Research Center for Parkinson's Disease of Capital Medical University, Beijing, China
- Department of Biobank, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Jagadish K Chhetri
- National Clinical Research Center for Geriatric Disorders, Beijing, China
| | - Shuying Liu
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Wei Mao
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Piu Chan
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
- Department of Neurobiology, Xuanwu Hospital of Capital Medical University, Beijing, China
- Key Laboratory for Neurodegenerative Diseases of the Ministry of Education, Beijing Key Laboratory on Parkinson's Disease, Parkinson's Disease Center for Beijing Institute on Brain Disorders, Clinical and Research Center for Parkinson's Disease of Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Disorders, Beijing, China
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Seuthe J, Hermanns H, Hulzinga F, D'Cruz N, Deuschl G, Ginis P, Nieuwboer A, Schlenstedt C. Gait asymmetry and symptom laterality in Parkinson's disease: two of a kind? J Neurol 2024:10.1007/s00415-024-12379-0. [PMID: 38652262 DOI: 10.1007/s00415-024-12379-0] [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: 03/15/2024] [Revised: 04/07/2024] [Accepted: 04/08/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND The laterality of motor symptoms is considered a key feature of Parkinson's disease (PD). Here, we investigated whether gait and turning asymmetry coincided with symptom laterality as determined by the MDS-UPRDS part III and whether it was increased compared to healthy controls (HC). METHODS We analyzed the asymmetry of gait and turning with and without a cognitive dual task (DT) using motion capture systems and wearable sensors in 97 PD patients mostly from Hoehn & Yahr stage II and III and 36 age-matched HC. We also assessed motor symptom asymmetry using the bilateral sub-items of the MDS-UPDRS-III. Finally, we examined the strength of the association between gait asymmetry and symptom laterality. RESULTS Participants with PD had increased gait but not more turning asymmetry compared to HC (p < 0.05). Only 53.7% of patients had a shorter step length on the more affected body side as determined by the MDS-UPDRS-III. Also, 54% took more time and 29% more steps during turns toward the more affected side. The degree of asymmetry in the different domains did not correlate with each other and was not influenced by DT-load. CONCLUSIONS We found a striking mismatch between the side and the degree of asymmetry in different motor domains, i.e., in gait, turning, and distal symptom severity in individuals with PD. We speculate that motor execution in different body parts relies on different neural control mechanisms. Our findings warrant further investigation to understand the complexity of gait asymmetry in PD.
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Affiliation(s)
- Jana Seuthe
- Institute of Interdisciplinary Exercise Science and Sports Medicine, Medical School Hamburg, Hamburg, Germany.
- Department of Neurology, Christian-Albrechts-University Kiel, University Hospital Schleswig-Holstein, Kiel, Germany.
| | - Helen Hermanns
- Department of Neurology, Christian-Albrechts-University Kiel, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Femke Hulzinga
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Louvain, Belgium
| | - Nicholas D'Cruz
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Louvain, Belgium
| | - Günther Deuschl
- Department of Neurology, Christian-Albrechts-University Kiel, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Pieter Ginis
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Louvain, Belgium
| | - Alice Nieuwboer
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Louvain, Belgium
| | - Christian Schlenstedt
- Institute of Interdisciplinary Exercise Science and Sports Medicine, Medical School Hamburg, Hamburg, Germany
- Department of Neurology, Christian-Albrechts-University Kiel, University Hospital Schleswig-Holstein, Kiel, Germany
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Gholami M, Ward R, Mahal R, Mirian M, Yen K, Park KW, McKeown MJ, Wang ZJ. Automatic labeling of Parkinson's Disease gait videos with weak supervision. Med Image Anal 2023; 89:102871. [PMID: 37480795 DOI: 10.1016/j.media.2023.102871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 06/01/2023] [Accepted: 06/12/2023] [Indexed: 07/24/2023]
Abstract
Motor dysfunction in Parkinson's Disease (PD) patients is typically assessed by clinicians employing the Movement Disorder Society's Unified Parkinson's Disease Rating Scale (MDS-UPDRS). Such comprehensive clinical assessments are time-consuming, expensive, semi-subjective, and may potentially result in conflicting labels across different raters. To address this problem, we propose an automatic, objective, and weakly-supervised method for labeling PD patients' gait videos. The proposed method accepts videos of patients and classifies their gait scores as normal (Gait score in MDS-UPDRS = 0) or PD (MDS-UPDRS ≥ 1). Unlike previous work, the proposed method does not require a priori MDS-UPDRS ratings for training, utilizing only domain-specific knowledge obtained from neurologists. We propose several labeling functions that classify patients' gait and use a generative model to learn the accuracy of each labeling function in a self-supervised manner. Since results depended upon the estimated values of the patients' 3D poses, and existing pre-trained 3D pose estimators did not yield accurate results, we propose a weakly-supervised 3D human pose estimation method for fine-tuning pre-trained models in a clinical setting. Using leave-one-out evaluations, the proposed method obtains an accuracy of 89% on a dataset of 29 PD subjects - a significant improvement compared to previous work by 7%-10% depending upon the dataset. The method obtained state-of-the-art results on the Human3.6M dataset. Our results suggest that the use of labeling functions may provide a robust means to interpret and classify patient-oriented videos involving motor tasks.
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Affiliation(s)
- Mohsen Gholami
- Department of Electrical and Computer Engineering, University of British Columbia, Canada.
| | - Rabab Ward
- Department of Electrical and Computer Engineering, University of British Columbia, Canada.
| | - Ravneet Mahal
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.
| | - Maryam Mirian
- Department of Electrical and Computer Engineering, University of British Columbia, Canada.
| | - Kevin Yen
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.
| | - Kye Won Park
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.
| | - Martin J McKeown
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada; Department of Medicine (Neurology), UBC, Canada.
| | - Z Jane Wang
- Department of Electrical and Computer Engineering, University of British Columbia, Canada.
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Giannakou E, Fotiadou S, Gourgoulis V, Mavrommatis G, Aggelousis N. A Comparative Analysis of Symmetry Indices for Spatiotemporal Gait Features in Early Parkinson's Disease. Neurol Int 2023; 15:1129-1139. [PMID: 37755361 PMCID: PMC10535875 DOI: 10.3390/neurolint15030070] [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: 07/19/2023] [Revised: 08/19/2023] [Accepted: 09/05/2023] [Indexed: 09/28/2023] Open
Abstract
This study compared the five most commonly used equations for calculating gait symmetry in discrete variables among Parkinson's disease patients. Twelve patients (five women and seven men) performed ten consecutive gait trials on a 10 m walkway. Gait data were collected using eight optoelectronic cameras (100 fr/s). The analysis focused on various spatiotemporal parameters, including cadence, step time, stride time, single support, double support, walking speed, step length, stride length, step width, and foot angle. Five symmetry indices were calculated for each trial rather than averaging the ten recorded trials. The variability in and reliability of each symmetry equation were assessed using the coefficient of variation (CV) and intraclass correlation coefficient (ICC), respectively. Additionally, Bland-Altman plots were produced to visualize the agreement between each pair of methods for each spatiotemporal parameter. The results revealed that the symmetry ratio method exhibited lower variability and higher reliability compared with the other four indices across all spatiotemporal gait parameters. However, it was found that the reliability of a single trial was generally poor, regardless of the symmetry calculation formula used. Therefore, we recommend basing measurements of gait asymmetry in Parkinson's disease on multiple trials.
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Affiliation(s)
- Erasmia Giannakou
- Department of Physical Education and Sport Science, School of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece; (E.G.); (S.F.); (V.G.)
| | - Styliani Fotiadou
- Department of Physical Education and Sport Science, School of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece; (E.G.); (S.F.); (V.G.)
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Vassilios Gourgoulis
- Department of Physical Education and Sport Science, School of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece; (E.G.); (S.F.); (V.G.)
| | - Georgios Mavrommatis
- Department of Physical Education and Sport Science, School of Physical Education and Sport Science, Aristotle University of Thessaloniki, 57001 Thessaloniki, Greece;
| | - Nikolaos Aggelousis
- Department of Physical Education and Sport Science, School of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece; (E.G.); (S.F.); (V.G.)
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Patoz A, Malatesta D, Burtscher J. Isolating the speed factor is crucial in gait analysis for Parkinson's disease. Front Neurosci 2023; 17:1119390. [PMID: 37152600 PMCID: PMC10160620 DOI: 10.3389/fnins.2023.1119390] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/31/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction Parkinson's disease (PD) is characterized by an alteration of the walking gait, frequently including a slower self-selected walking speed (SSWS). Although the reduction of walking speed is inherent to people with PD, such speed reduction also represents a potential confounding factor that might partly explain the observed gait differences between PD and control participants. Methods In this study, each participant walked along a 25 m level corridor during which vertical ground reaction force signals were recorded using shoes equipped with eight pressure sensors. Vertical ground reaction force signals (using statistical parametric mapping) and temporal and kinetic variables as well as their related variability and asymmetry (using Student's t-test) were compared between PD (n = 54) and walking-speed-matched control subjects (n = 39). Results Statistical parametric mapping did not yield significant differences between PD and control groups for the vertical ground reaction force signal along the walking stance phase. Stride time and single support time (equivalent to swing time) were shorter and peak vertical ground reaction force was larger in PD patients compared to controls (p ≤ 0.05). However, the single support time was no longer different between people with PD and healthy subjects when expressed relatively to stride time (p = 0.07). While single support, double support, and stance times were significantly more variable and asymmetric for PD than for the control group (p ≤ 0.05), stride time was similar (p ≥ 0.07). Discussion These results indicate that at matched SSWS, PD patients adopt a higher cadence than control participants. Moreover, the temporal subdivision of the walking gait of people with PD is similar to healthy individuals but the coordination during the double support phase is different. Hence, this study indicates that isolating the speed factor is crucial in gait analysis for PD.
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Affiliation(s)
- Aurélien Patoz
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
- Research and Development Department, Volodalen Swiss Sport Lab, Aigle, Switzerland
- *Correspondence: Aurélien Patoz,
| | - Davide Malatesta
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Johannes Burtscher
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
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Faria MH, Simieli L, Rietdyk S, Penedo T, Santinelli FB, Barbieri FA. (A)symmetry during gait initiation in people with Parkinson's disease: A motor and cortical activity exploratory study. Front Aging Neurosci 2023; 15:1142540. [PMID: 37139089 PMCID: PMC10150081 DOI: 10.3389/fnagi.2023.1142540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/28/2023] [Indexed: 05/05/2023] Open
Abstract
Background Gait asymmetry and deficits in gait initiation (GI) are among the most disabling symptoms in people with Parkinson's disease (PwPD). Understanding if PwPD with reduced asymmetry during GI have higher asymmetry in cortical activity may provide support for an adaptive mechanism to improve GI, particularly in the presence of an obstacle. Objective This study quantified the asymmetry of anticipatory postural adjustments (APAs), stepping parameters and cortical activity during GI, and tested if the presence of an obstacle regulates asymmetry in PwPD. Methods Sixteen PwPD and 16 control group (CG) performed 20-trials in two conditions: unobstructed and obstructed GI with right and left limbs. We measured, through symmetry index, (i) motor parameters: APAs and stepping, and (ii) cortical activity: the PSD of the frontal, sensorimotor and occipital areas during APA, STEP-I (moment of heel-off of the leading foot in the GI until the heel contact of the same foot); and STEP-II (moment of the heel-off of the trailing foot in the GI until the heel contact of the same foot) phases. Results Parkinson's disease showed higher asymmetry in cortical activity during APA, STEP-I and STEP-II phases and step velocity (STEP-II phase) during unobstructed GI than CG. However, unexpectedly, PwPD reduced the level of asymmetry of anterior-posterior displacement (p < 0.01) and medial-lateral velocity (p < 0.05) of the APAs. Also, when an obstacle was in place, PwPD showed higher APAs asymmetry (medial-lateral velocity: p < 0.002), with reduced and increased asymmetry of the cortical activity during APA and STEP-I phases, respectively. Conclusion Parkinson's disease were not motor asymmetric during GI, indicating that higher cortical activity asymmetry can be interpreted as an adaptive behavior to reduce motor asymmetry. In addition, the presence of obstacle did not regulate motor asymmetry during GI in PwPD.
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Affiliation(s)
- Murilo Henrique Faria
- Human Movement Research Laboratory (MOVI-LAB), School of Sciences, Department of Physical Education, São Paulo State University (Unesp), Bauru, São Paulo, Brazil
| | - Lucas Simieli
- Human Movement Research Laboratory (MOVI-LAB), School of Sciences, Department of Physical Education, São Paulo State University (Unesp), Bauru, São Paulo, Brazil
| | - Shirley Rietdyk
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, United States
| | - Tiago Penedo
- Human Movement Research Laboratory (MOVI-LAB), School of Sciences, Department of Physical Education, São Paulo State University (Unesp), Bauru, São Paulo, Brazil
| | - Felipe Balistieri Santinelli
- Human Movement Research Laboratory (MOVI-LAB), School of Sciences, Department of Physical Education, São Paulo State University (Unesp), Bauru, São Paulo, Brazil
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Fabio Augusto Barbieri
- Human Movement Research Laboratory (MOVI-LAB), School of Sciences, Department of Physical Education, São Paulo State University (Unesp), Bauru, São Paulo, Brazil
- *Correspondence: Fabio Augusto Barbieri,
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Shamsi F, Nami M, Aligholi H, Borhani-Haghighi A, Kavyani M, Karimi MT. The effect of action observation training on gait and balance of patients with neurological and musculoskeletal disorders: A systematic review. Br J Occup Ther 2022. [DOI: 10.1177/03080226221098943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Various treatment approaches are being applied for recovery of gait after different medical conditions. Action observation is a new motor learning approach, which is considered as a complementary training to the conventional rehabilitation programs such as occupational therapy for this purpose. Objective To find out which patients benefit more from action observation training. Methods Electronic databases, including Scopus, PubMed, Web of Science, Science Direct, and PEDro were searched. Prospective studies published in peer-reviewed journals with full text available in English, which investigated the effect of action observation on gait and balance of patients with neurologic or musculoskeletal disorders, were included. The methodological quality of the studies was assessed by the Downs and Black checklist, and the information was presented based on the PICO style. Results Nineteen studies recruiting post-orthopedic patients (4 studies), patients with stroke (11 studies), and Parkinson’s disease (4 studies) fulfilled the eligibility criteria. Quality scores ranged from 51.85% to 81.48%. Balance and walking ability were the most reported primary outcomes. Conclusion Patients in the chronic phase of stroke might benefit more from action observation training plus occupational therapy in different aspects of gait than orthopedic patients and those with Parkinson’s disease.
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Affiliation(s)
- Fatemeh Shamsi
- Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
- Neuroscience Laboratory (Brain, Cognition and Behavior), Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Nami
- Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
- Neuroscience Laboratory (Brain, Cognition and Behavior), Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
- Neuroscience Center, Instituto de Investigaciones Científicas Servicios de Alta Tecnología (INDICASAT AIP), City of Knowledge, Panama City, Panama
| | - Hadi Aligholi
- Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
- Neuroscience Laboratory (Brain, Cognition and Behavior), Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mahsa Kavyani
- Musculoskeletal Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad T Karimi
- Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Bastos P, Meira B, Mendonça M, Barbosa R. Distinct gait dimensions are modulated by physical activity in Parkinson's disease patients. J Neural Transm (Vienna) 2022; 129:879-887. [PMID: 35426538 PMCID: PMC9011371 DOI: 10.1007/s00702-022-02501-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/06/2022] [Indexed: 11/27/2022]
Abstract
Parkinson’s disease (PD) is the fastest growing neurodegenerative disease, but disease-modifying or preventive treatments are lacking. Physical activity is a modifiable factor that decreases the PD risk and improves motor symptoms in PD. Understanding which dimensions of gait performance correlate with physical activity in PD can have important pathophysiological and therapeutic implications. Clinical/demographic data together with physical activity levels were collected from thirty-nine PD patients. Gait analysis was performed wearing seven inertial measurement units on the lower body, reconstructing the subjects’ lower body motion using 3D kinematic biomechanical models. Higher physical activity scores were significantly correlated with MDS-UPDRS part III scores (r = − 0.58, p value = 9.2 × 10−5), age (r = − 0.39, p value = 1.5 × 10−2) and quality-of-life (r = − 0.47, p value = 5.9 × 10−3). Physical activity was negatively associated with MDS-UPDRS part III scores after adjusting for age and disease duration (β = − 0.08530, p value = 0.0010). The effect of physical activity on quality-of-life was mediated by the MDS-UPDRS part III (62.10%, 95% CI = 0.0758–1.78, p value = 0.022). The level of physical activity was correlated primarily with spatiotemporal performance. While spatiotemporal performance displays the strongest association with physical activity, other quality-of-movement dimensions of clinical relevance (e.g., smoothness, rhythmicity) fail to do so. Interventions targeting these ought to be leveraged for performance enhancement in PD through neuroprotective and brain network connectivity strengthening. It remains to be ascertained to which extent these are amenable to modulation.
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Affiliation(s)
- Paulo Bastos
- CEDOC, Chronic Diseases Research Centre, NOVA Medical School, Lisbon, Portugal
| | - Bruna Meira
- Neurology Department, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Marcelo Mendonça
- Champalimaud Research, Champalimaud Centre for the Unknown, Lisbon, Portugal
- NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Raquel Barbosa
- Neurology Department, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
- NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.
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Arippa F, Leban B, Monticone M, Cossu G, Casula C, Pau M. A Study on Lower Limb Asymmetries in Parkinson’s Disease during Gait Assessed through Kinematic-Derived Parameters. Bioengineering (Basel) 2022; 9:bioengineering9030120. [PMID: 35324809 PMCID: PMC8945156 DOI: 10.3390/bioengineering9030120] [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: 02/21/2022] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 11/29/2022] Open
Abstract
Unilaterality of motor symptoms is a distinctive feature of Parkinson’s Disease (PD) and represents an important co-factor involved in motor deficits and limitations of functional abilities including postural instability and asymmetrical gait. In recent times, an increasing number of studies focused on the characterization of such alterations, which have been associated with increased metabolic cost and risk of falls and may severely compromise their quality of life. Although a large number of studies investigated the gait alterations in people with PD (pwPD), few focused on kinematic parameters and even less investigated interlimb asymmetry under a kinematic point of view. This retrospective study aimed to characterize such aspects in a cohort of 61 pwPD (aged 68.9 ± 9.3 years) and 47 unaffected individuals age- and sex-matched (66.0 ± 8.3 years), by means of computerized 3D gait analysis performed using an optical motion-capture system. The angular trends at hip, knee and ankle joints of pwPD during the gait cycle were extracted and compared with those of unaffected individuals on a point-by-point basis. Interlimb asymmetry was assessed using angle–angle diagrams (cyclograms); in particular, we analyzed area, orientation, trend symmetry and range offset. The results showed that pwPD are characterized by a modified gait pattern particularly at the terminal stance/early swing phase of the gait cycle. Significant alterations of interlimb coordination were detected at the ankle joint (cyclogram orientation and trend symmetry) and at the hip joint (range offset). Such findings might be useful in clinical routine to characterize asymmetry during gait and thus support physicians in the early diagnosis and in the evaluation of the disease progression.
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Affiliation(s)
- Federico Arippa
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy; (F.A.); (B.L.)
- Neurorehabilitation Unit, Department of Neuroscience and Rehabilitation, ARNAS “G. Brotzu”, 09134 Cagliari, Italy;
| | - Bruno Leban
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy; (F.A.); (B.L.)
| | - Marco Monticone
- Neurorehabilitation Unit, Department of Neuroscience and Rehabilitation, ARNAS “G. Brotzu”, 09134 Cagliari, Italy;
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, Italy
| | - Giovanni Cossu
- Neurophysiology and Movement Disorders Unit, Department of Neurology, ARNAS “G. Brotzu”, 09134 Cagliari, Italy;
| | - Carlo Casula
- Physical Medicine and Rehabilitation Unit, ARNAS “G. Brotzu”, 09134 Cagliari, Italy;
| | - Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy; (F.A.); (B.L.)
- Correspondence:
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11
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Corradini JR, Silveira-Ciola AP, Pereira VAI, Kuroda MH, Faria MH, Simieli L, Tavares JMRS, Barbieri FA. Dual tasking reduces gait asymmetry of trajectory deviation during obstacle circumvention in people with Parkinson's disease. Hum Mov Sci 2022; 83:102938. [PMID: 35276426 DOI: 10.1016/j.humov.2022.102938] [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: 05/18/2021] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Certain aspects of gait may depend on cognition, and the effects of dual-tasking (DT) on gait asymmetry (GA) during obstacle circumvention in people with Parkinson's disease (pwPD) may be walking phase-dependent. While the approaching phase requires allocating significant cognitive resources to perform the task, outweighing the available resources may increase GA. During the avoiding phase, the obstacle could be used as an external cue, enhancing the attention to the obstacle and, consequently, improving gait control and regulating GA. OBJECTIVE The study investigated the effects of obstacle circumvention during gait with DT on GA in pwPD, considering the circumvention phase. METHODS Thirty participants, 15 pwPD and 15 neurologically healthy individuals, circumvented an obstacle 20 times (in total) according to side (right and left side) and DT (presence and absence). Spatial-temporal stride parameters, medial-lateral and horizontal trajectory deviations from the original path, strategy to obstacle circumvention (lead limb away from or close to the obstacle during the crossing step), and gaze parameters were calculated during the approaching and avoiding phases. The parameters were grouped considering the side that the obstacle was circumvented during each task, and the symmetry index was calculated. RESULTS The results showed greater asymmetry of time of fixations, width, duration, and velocity during the approaching phase (p < 0.02), whereas the avoiding phase decreased asymmetry of medial-lateral and horizontal trajectory deviations parameters (p < 0.001) during obstacle circumvention with DT, in both pwPD and control group. CONCLUSIONS The findings offer a basis for considering that goal-directed movement control may regulate GA in pwPD.
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Affiliation(s)
- Julia R Corradini
- São Paulo State University (Unesp), School of Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, SP, Brazil
| | - Aline P Silveira-Ciola
- São Paulo State University (Unesp), School of Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, SP, Brazil
| | - Vinicius A I Pereira
- São Paulo State University (Unesp), School of Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, SP, Brazil; University of South Australia - Education Future Academic Unit, Australia
| | - Marina H Kuroda
- São Paulo State University (Unesp), School of Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, SP, Brazil
| | - Murilo H Faria
- São Paulo State University (Unesp), School of Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, SP, Brazil
| | - Lucas Simieli
- São Paulo State University (Unesp), School of Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, SP, Brazil
| | - João Manuel R S Tavares
- Instituto de Ciência e Inovação em Engenharia Mecânica e Engenharia Industrial, Departamento de Engenharia Mecânica, Faculdade de Engenharia, Universidade do Porto, Porto, Portugal
| | - Fabio A Barbieri
- São Paulo State University (Unesp), School of Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, SP, Brazil.
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12
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Park H, Shin S, Youm C, Cheon SM, Lee M, Noh B. Classification of Parkinson's disease with freezing of gait based on 360° turning analysis using 36 kinematic features. J Neuroeng Rehabil 2021; 18:177. [PMID: 34930373 PMCID: PMC8686361 DOI: 10.1186/s12984-021-00975-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Freezing of gait (FOG) is a sensitive problem, which is caused by motor control deficits and requires greater attention during postural transitions such as turning in people with Parkinson's disease (PD). However, the turning characteristics have not yet been extensively investigated to distinguish between people with PD with and without FOG (freezers and non-freezers) based on full-body kinematic analysis during the turning task. The objectives of this study were to identify the machine learning model that best classifies people with PD and freezers and reveal the associations between clinical characteristics and turning features based on feature selection through stepwise regression. METHODS The study recruited 77 people with PD (31 freezers and 46 non-freezers) and 34 age-matched older adults. The 360° turning task was performed at the preferred speed for the inner step of the more affected limb. All experiments on the people with PD were performed in the "Off" state of medication. The full-body kinematic features during the turning task were extracted using the three-dimensional motion capture system. These features were selected via stepwise regression. RESULTS In feature selection through stepwise regression, five and six features were identified to distinguish between people with PD and controls and between freezers and non-freezers (PD and FOG classification problem), respectively. The machine learning model accuracies revealed that the random forest (RF) model had 98.1% accuracy when using all turning features and 98.0% accuracy when using the five features selected for PD classification. In addition, RF and logistic regression showed accuracies of 79.4% when using all turning features and 72.9% when using the six selected features for FOG classification. CONCLUSION We suggest that our study leads to understanding of the turning characteristics of people with PD and freezers during the 360° turning task for the inner step of the more affected limb and may help improve the objective classification and clinical assessment by disease progression using turning features.
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Affiliation(s)
- Hwayoung Park
- Department of Health Sciences, The Graduate School of Dong-A University, Saha-gu, Busan, Republic of Korea
| | - Sungtae Shin
- Department of Mechanical Engineering, College of Engineering, Dong-A University, Saha-gu, Busan, Republic of Korea
| | - Changhong Youm
- Department of Health Sciences, The Graduate School of Dong-A University, Saha-gu, Busan, Republic of Korea.
- Department of Healthcare and Science, College of Health Sciences, Dong-A University, 37 Nakdong‑Daero, 550 Beon‑gil, Hadan 2-dong, Saha-gu, Busan, 49315, Republic of Korea.
| | - Sang-Myung Cheon
- Department of Neurology, School of Medicine, Dong-A University, 26, Daesingongwon-ro, Seo-gu, Busan, 49201, Republic of Korea.
| | - Myeounggon Lee
- Department of Health and Human Performance, Center for Neuromotor and Biomechanics Research, University of Houston, Houston, TX, USA
| | - Byungjoo Noh
- Department of Kinesiology, Jeju National University, Jeju-si, Jeju-do, Republic of Korea
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13
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Godi M, Arcolin I, Giardini M, Corna S, Schieppati M. A pathophysiological model of gait captures the details of the impairment of pace/rhythm, variability and asymmetry in Parkinsonian patients at distinct stages of the disease. Sci Rep 2021; 11:21143. [PMID: 34707168 PMCID: PMC8551236 DOI: 10.1038/s41598-021-00543-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/05/2021] [Indexed: 01/15/2023] Open
Abstract
Locomotion in people with Parkinson' disease (pwPD) worsens with the progression of disease, affecting independence and quality of life. At present, clinical practice guidelines recommend a basic evaluation of gait, even though the variables (gait speed, cadence, step length) may not be satisfactory for assessing the evolution of locomotion over the course of the disease. Collecting variables into factors of a conceptual model enhances the clinical assessment of disease severity. Our aim is to evaluate if factors highlight gait differences between pwPD and healthy subjects (HS) and do it at earlier stages of disease compared to single variables. Gait characteristics of 298 pwPD and 84 HS able to walk without assistance were assessed using a baropodometric walkway (GAITRite®). According to the structure of a model previously validated in pwPD, eight spatiotemporal variables were grouped in three factors: pace/rhythm, variability and asymmetry. The model, created from the combination of three factor scores, proved to outperform the single variables or the factors in discriminating pwPD from HS. When considering the pwPD split into the different Hoehn and Yahr (H&Y) stages, the spatiotemporal variables, factor scores and the model showed that multiple impairments of gait appear at H&Y stage 2.5, with the greatest difference from HS at stage 4. A contrasting behavior was found for the asymmetry variables and factor, which showed differences from the HS already in the early stages of PD. Our findings support the use of factor scores and of the model with respect to the single variables in gait staging in PD.
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Affiliation(s)
- Marco Godi
- Division of Physical Medicine and Rehabilitation, Scientific Institute of Veruno, Istituti Clinici Scientifici Maugeri IRCCS, 28010, Gattico-Veruno, NO, Italy
| | - Ilaria Arcolin
- Division of Physical Medicine and Rehabilitation, Scientific Institute of Veruno, Istituti Clinici Scientifici Maugeri IRCCS, 28010, Gattico-Veruno, NO, Italy.
| | - Marica Giardini
- Division of Physical Medicine and Rehabilitation, Scientific Institute of Veruno, Istituti Clinici Scientifici Maugeri IRCCS, 28010, Gattico-Veruno, NO, Italy
| | - Stefano Corna
- Division of Physical Medicine and Rehabilitation, Scientific Institute of Veruno, Istituti Clinici Scientifici Maugeri IRCCS, 28010, Gattico-Veruno, NO, Italy
| | - Marco Schieppati
- Scientific Institute of Pavia, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy
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14
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Ravi DK, Baumann CR, Bernasconi E, Gwerder M, Ignasiak NK, Uhl M, Stieglitz L, Taylor WR, Singh NB. Does Subthalamic Deep Brain Stimulation Impact Asymmetry and Dyscoordination of Gait in Parkinson's Disease? Neurorehabil Neural Repair 2021; 35:1020-1029. [PMID: 34551639 PMCID: PMC8593318 DOI: 10.1177/15459683211041309] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Subthalamic deep brain stimulation (STN-DBS) is an effective treatment for selected Parkinson's disease (PD) patients. Gait characteristics are often altered after surgery, but quantitative therapeutic effects are poorly described. Objective. The goal of this study was to systematically investigate modifications in asymmetry and dyscoordination of gait 6 months postoperatively in patients with PD and compare the outcomes with preoperative baseline and to asymptomatic controls without PD. Methods. A convenience sample of thirty-two patients with PD (19 with postural instability and gait disorder (PIGD) type and 13 with tremor dominant disease) and 51 asymptomatic controls participated. Parkinson patients were tested prior to the surgery in both OFF and ON medication states, and 6-months postoperatively in the ON stimulation condition. Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) I to IV and medication were compared to preoperative conditions. Asymmetry ratios, phase coordination index, and walking speed were assessed. Results. MDS-UPDRS I to IV at 6 months improved significantly, and levodopa equivalent daily dosages significantly decreased. STN-DBS increased step time asymmetry (hedges' g effect sizes [95% confidence interval] between pre- and post-surgery: .27 [-.13, .73]) and phase coordination index (.29 [-.08, .67]). These effects were higher in the PIGD subgroup than the tremor dominant (step time asymmetry: .38 [-.06, .90] vs .09 [-.83, 1.0] and phase coordination index: .39 [-.04, .84] vs .13 [-.76, .96]). Conclusions. This study provides objective evidence of how STN-DBS increases asymmetry and dyscoordination of gait in patients with PD and suggests motor subtypes-associated differences in the treatment response.
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Affiliation(s)
- Deepak K Ravi
- Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
| | | | | | | | - Niklas K Ignasiak
- Department of Physical Therapy, 6226Chapman University, Irvine, CA, USA
| | - Mechtild Uhl
- Department of Neurology, University Hospital Zürich, Zürich, Switzerland
| | - Lennart Stieglitz
- Department of Neurology, University Hospital Zürich, Zürich, Switzerland
| | | | - Navrag B Singh
- Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
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15
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Lee HA, Kim DH. Brain Connectivity Affecting Gait Function After Unilateral Supratentorial Stroke. Brain Sci 2021; 11:brainsci11070870. [PMID: 34210030 PMCID: PMC8301903 DOI: 10.3390/brainsci11070870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 06/24/2021] [Accepted: 06/24/2021] [Indexed: 11/16/2022] Open
Abstract
Gait dysfunction is a leading cause of long-term disability after stroke. The mechanisms underlying recovery of gait function are unknown. We retrospectively evaluated the association between structural connectivity and gait function in 127 patients with unilateral supratentorial stroke (>1 month after stroke). All patients underwent T1-weighted, diffusion tensor imaging and functional ambulation categorization. Voxel-wise linear regression analyses of the images were conducted using fractional anisotropy, mean diffusivity, and mode of anisotropy mapping as dependent variables, while the functional ambulation category was used as an independent variable with age and days after stroke as covariates. The functional ambulation category was positively associated with increased fractional anisotropy in the lesioned cortico-ponto-cerebellar system, corona radiata of the non-lesioned corticospinal tract pathway, bilateral medial lemniscus in the brainstem, and the corpus callosum. The functional ambulation category was also positively associated with increased mode of anisotropy in the lesioned posterior corpus callosum. In conclusion, structural connectivity associated with motor coordination and feedback affects gait function after stroke. Diffusion tensor imaging for evaluating structural connectivity can help to predict gait recovery and target rehabilitation goals after stroke.
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Affiliation(s)
- Hyun-Ah Lee
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul 05368, Korea;
| | - Dae-Hyun Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
- Correspondence: ; Tel.: +82-2-2228-3724
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16
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Spatio-temporal gait parameters obtained from foot-worn inertial sensors are reliable in healthy adults in single- and dual-task conditions. Sci Rep 2021; 11:10229. [PMID: 33986307 PMCID: PMC8119721 DOI: 10.1038/s41598-021-88794-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 04/07/2021] [Indexed: 02/07/2023] Open
Abstract
Inertial measurement units (IMUs) are increasingly popular and may be usable in clinical routine to assess gait. However, assessing their intra-session reliability is crucial and has not been tested with foot-worn sensors in healthy participants. The aim of this study was to assess the intra-session reliability of foot-worn IMUs for measuring gait parameters in healthy adults. Twenty healthy participants were enrolled in the study and performed the 10-m walk test in single- and dual-task ('carrying a full cup of water') conditions, three trials per condition. IMUs were used to assess spatiotemporal gait parameters, gait symmetry parameters (symmetry index (SI) and symmetry ratio (SR)), and dual task effects parameters. The relative and the absolute reliability were calculated for each gait parameter. Results showed that spatiotemporal gait parameters measured with foot-worn inertial sensors were reliable; symmetry gait parameters relative reliability was low, and SR showed better absolute reliability than SI; dual task effects were poorly reliable, and taking the mean of the second and the third trials was the most reliable. Foot-worn IMUs are reliable to assess spatiotemporal and symmetry ratio gait parameters but symmetry index and DTE gait parameters reliabilities were low and need to be interpreted with cautious by clinicians and researchers.
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17
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Sivaramakrishnan A, Madhavan S. Reliability of transcallosal inhibition measurements for the lower limb motor cortex in stroke. Neurosci Lett 2021; 743:135558. [PMID: 33352282 PMCID: PMC7855415 DOI: 10.1016/j.neulet.2020.135558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/03/2020] [Accepted: 12/07/2020] [Indexed: 11/29/2022]
Abstract
Transcallosal inhibition (TCI) is a measure of between-hemisphere inhibitory control that can be evaluated with the ipsilateral silent period (iSP) transcranial magnetic stimulation (TMS) paradigm. The study of iSP for the lower extremity has been limited possibly due to the close orientation of the lower extremity motor representations. Change in TCI can provide insights into pathophysiological mechanisms underlying the asymmetry in corticomotor excitability in stroke. Here, we describe a method for iSP quantification and report reliability of iSP parameters for the tibialis anterior (TA) muscle in stroke. 26 individuals with stroke attended three sessions where single pulse TMS was used to measure TCI from the lesioned to non-lesioned hemisphere. A double cone coil was used for stimulating the ipsilateral motor cortex while the participant maintained an isometric contraction of the non-paretic TA. Absolute and relative reliability were computed for iSP latency, duration and area. iSP latency showed the lowest measurement error (absolute reliability) and iSP latency, duration and area showed good relative reliability (intraclass correlation coefficients > 0.6). This study suggests that iSP parameters for the tibialis anterior are reliable and attempts to provide a guideline for evaluating TCI for the lower extremity in stroke and other clinical populations.
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Affiliation(s)
- Anjali Sivaramakrishnan
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago (UIC), USA; Graduate Program in Rehabilitation Sciences, College of Applied Health Sciences, UIC, USA
| | - Sangeetha Madhavan
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago (UIC), USA.
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18
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Effect of Parkinson's disease and two therapeutic interventions on muscle activity during walking: a systematic review. NPJ PARKINSONS DISEASE 2020; 6:22. [PMID: 32964107 PMCID: PMC7481232 DOI: 10.1038/s41531-020-00119-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 07/09/2020] [Indexed: 12/26/2022]
Abstract
Gait deficits are a common feature of Parkinson’s disease (PD) and predictors of future motor and cognitive impairment. Understanding how muscle activity contributes to gait impairment and effects of therapeutic interventions on motor behaviour is crucial for identifying potential biomarkers and developing rehabilitation strategies. This article reviews sixteen studies that investigate the electromyographic (EMG) activity of lower limb muscles in people with PD during walking and reports on their quality. The weight of evidence establishing differences in motor activity between people with PD and healthy older adults (HOAs) is considered. Additionally, the effect of dopaminergic medication and deep brain stimulation (DBS) on modifying motor activity is assessed. Results indicated greater proximal and decreased distal activity of lower limb muscles during walking in individuals with PD compared to HOA. Dopaminergic medication was associated with increased distal lower limb muscle activity whereas subthalamic nucleus DBS increased activity of both proximal and distal lower limb muscles. Tibialis anterior was impacted most by the interventions. Quality of the studies was not strong, with a median score of 61%. Most studies investigated only distal muscles, involved small sample sizes, extracted limited EMG features and lacked rigorous signal processing. Few studies related changes in motor activity with functional gait measures. Understanding mechanisms underpinning gait impairment in PD is essential for development of personalised rehabilitative interventions. Recommendations for future studies include greater participant numbers, recording more functionally diverse muscles, applying multi-muscle analyses, and relating EMG to functional gait measures.
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19
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Wu J, Guo T, Zhou C, Gao T, Guan X, Xuan M, Gu Q, Huang P, Song Z, Xu X, Zhang M. Disrupted interhemispheric coordination with unaffected lateralization of global eigenvector centrality characterizes hemiparkinsonism. Brain Res 2020; 1742:146888. [PMID: 32439342 DOI: 10.1016/j.brainres.2020.146888] [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: 03/12/2020] [Revised: 04/12/2020] [Accepted: 05/12/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The motor dysfunctions always affect hemi-body first in Parkinson's disease (PD). However, the interhemispheric relationships in patients with only unilateral motor impairment were barely known to date. We aimed to investigate the interhemispheric functions using resting-state functional Magnetic resonance imaging (RS-fMRI) for further understanding the pathogenesis of PD. METHODS Forty-three unilateral-symptomatic PD patients (UPD, Hoehn-Yahr staging scale, H-Y: 1-1.5), and 54 age-, gender-, education-matched normal controls (NC) were recruited. All subjects underwent MRI scanning and clinical evaluations. The interhemispheric coordination (Voxel-Mirrored Homotopic Connectivity, VMHC) and hemispheric dominance pattern (laterality index of eigenvector centrality mapping, LI-ECM) were calculated. Afterwards, correlation analyses and receiver operating characteristic (ROC) curve analysis were employed. RESULTS Compared with NC, UPD group showed significantly decreased VMHC in bilateral sensorimotor regions which was negatively correlated with the motor score. Furthermore, at the cut-off homotopic connectivity of 0.604, statistically significant ability of VMHC to discriminate UPD from NC with area under ROC curve (AUC) = 0.759, p < 0.001; specificity = 74.4%; sensitivity = 68.5% was observed. No difference was detected in UPD patients as for ECM and LI-ECM. CONCLUSIONS The disrupted interhemispheric coordination in bilateral sensorimotor regions may have significant implications for elucidating the mechanisms underlying the hemiparkinsonism and enabling the uncovering of complex mechanisms of PD.
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Affiliation(s)
- Jingjing Wu
- 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
| | - Cheng Zhou
- 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
| | - Xiaojun Guan
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Min Xuan
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Quanquan Gu
- Department of Radiology, 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
| | - Zhe Song
- 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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20
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Abstract
The corpus callosum is an important neural structure for controlling and coordinating bilateral movements of the upper limbs; however, there remains a substantial lack of knowledge regarding its association with lower limb control. We argue that transcallosal structure is an integral neural mechanism underlying control of the lower limbs and callosal degradation is a key contributor to mobility declines.
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Affiliation(s)
| | - Brett W Fling
- Department of Health and Exercise Science.,Molecular, Cellular, and Integrative Neuroscience Program, Colorado State University, Fort Collins, CO
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21
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D'Cruz N, Vervoort G, Fieuws S, Moreau C, Vandenberghe W, Nieuwboer A. Repetitive Motor Control Deficits Most Consistent Predictors of Conversion to Freezing of Gait in Parkinson's Disease: A Prospective Cohort Study. JOURNAL OF PARKINSONS DISEASE 2020; 10:559-571. [PMID: 32039860 DOI: 10.3233/jpd-191759] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The onset of freezing of gait (FOG) represents a turning point in the lives of patients with Parkinson's disease (PD). FOG increases fall risk and is associated with worse physical and mental health related quality of life, thus increasing disease burden. Moreover, therapeutic studies aiming to ameliorate freezing have had limited success. In a step towards pre-emptive therapy to delay or prevent the onset of FOG, this prospective cohort study set out to uncover clinical markers of conversion to FOG. OBJECTIVE Investigate clinical markers of conversion to FOG. METHODS Sixty PD patients without FOG were followed up for two years and underwent extensive clinical testing each year. FOG classification was made with the New Freezing of Gait Questionnaire. Clinical predictors of conversion to FOG were investigated using univariate analysis and through building a multivariable model using all measured components. RESULTS Twelve patients developed FOG during the study (Incidence: 11.5% per year). Due to the large number of predictors, univariate analyses did not survive multiple comparison correction, precluding strong inference on any one predictor. Overall, the effect sizes suggested that motor deficits including difficulties with repetitive movement scaling (AUC: 0.71), coordination (AUC: 0.73) and consistency (AUC: 0.76) as well as gait asymmetry (AUC: 0.79) and variability (AUC: 0.71) were most predictive of conversion. Further, converters reported more subjective cognitive difficulty (AUC: 0.74), although their measured performance was similar to non-converters. Multivariable analyses further showed that the two components most consistently selected in the predictive model were: 1) an MDS-UPDRS component with worse axial motor, hand use and non-motor symptoms; and 2) finger tapping abnormalities. CONCLUSION Conversion to FOG was predicted mainly by objective and clinical measures of motor dyscontrol, as non-motor disturbances were surfacing. Although based on a small cohort with limited converters, this novel finding informs future studies aimed at FOG prevention.
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Affiliation(s)
- Nicholas D'Cruz
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group, Leuven, Belgium
| | - Griet Vervoort
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group, Leuven, Belgium
| | - Steffen Fieuws
- KU Leuven, Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), Leuven, Belgium
| | - Caroline Moreau
- University of Lille, Expert Center for Parkinson Disease, CHU Lille, Inserm UMR, France
| | - Wim Vandenberghe
- KU Leuven, Department of Neurosciences, Laboratory for Parkinson Research, Leuven, Belgium
| | - Alice Nieuwboer
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group, Leuven, Belgium
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22
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Double obstacles increase gait asymmetry during obstacle crossing in people with Parkinson's disease and healthy older adults: A pilot study. Sci Rep 2020; 10:2272. [PMID: 32042027 PMCID: PMC7010667 DOI: 10.1038/s41598-020-59266-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 01/27/2020] [Indexed: 11/17/2022] Open
Abstract
Gait asymmetry during unobstructed walking in people with Parkinson’s disease (PD) has been well documented. However, under complex situations, such as environments with double obstacles, gait asymmetry remains poorly understood in PD. Therefore, the aim of this study was to analyze inter-limb asymmetry while crossing a single obstacle and double obstacles (with different distances between them) in people with PD and healthy older adults. Nineteen people with PD and 19 healthy older people performed three conditions: (i) walking with one obstacle (Single); (ii) walking with two obstacles with a 50 cm distance between them (Double-50); (iii) walking with two obstacles with a 108 cm distance between them (Double-108). The participants performed the obstacle crossing with both lower limbs. Asymmetry Index was calculated. We found that people with PD presented higher leading and trailing toe clearance asymmetry than healthy older people. In addition, participants increased asymmetry in the Double-50 compared to Single condition. It can be concluded that people with PD show higher asymmetry during obstacle crossing compared to healthy older people, independently of the number of obstacles. In addition, a challenging environment induces asymmetry during obstacle crossing in both people with PD and healthy older people.
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23
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White matter alterations in early Parkinson's disease: role of motor symptom lateralization. Neurol Sci 2019; 41:357-364. [PMID: 31650438 DOI: 10.1007/s10072-019-04084-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 09/19/2019] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Parkinson's disease (PD) is a motor disorder that initially presents with unilateral symptoms. Widespread white matter (WM) alterations have been reported since the early stages of the disease. The aim of this study was to investigate WM alterations in right-dominant and left-dominant symptom PD patients (RPD and LPD, respectively) with respect to healthy controls (HC) by diffusion-weighted magnetic resonance imaging (MRI). METHODS Thirty-eight subjects participated in this study: 12 RPD (median H&Y [IQR] = 1.5 [1.1-2], median UPDRS III [IQR] = 23 [7.8-25]), 9 LPD (median H&Y [IQR] = 1.5 [1-2.5], median UPDRS III [IQR] = 17 [12-22]), and 17 HC. All the participants were scanned on a 1.5-T MRI scanner. Maps of fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were computed for all the subjects. Tract-based spatial statistics (TBSS) was performed for each diffusion parameter, to test WM differences between RPD, LPD, and HC (ANCOVA design). Family-wise error (FWE) correction was performed and p values lower than 0.05 were considered significant. RESULTS No significant FA and RD differences were observed between RPD, LPD, and HC. Significantly increased MD and AD were observed in RPD with respect to HC within widespread WM regions, bilaterally. Conversely, no significant WM alterations were detected in LPD. CONCLUSION WM integrity was found to be significantly altered in RPD but not in LPD, suggesting that LPD profile may be associated to more favorable prognosis. Since clinical laterality onset may affect the extent of WM integrity changes, it should be taken into account in neuroimaging studies investigating PD.
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Del Din S, Elshehabi M, Galna B, Hobert MA, Warmerdam E, Suenkel U, Brockmann K, Metzger F, Hansen C, Berg D, Rochester L, Maetzler W. Gait analysis with wearables predicts conversion to parkinson disease. Ann Neurol 2019; 86:357-367. [PMID: 31294853 PMCID: PMC6899833 DOI: 10.1002/ana.25548] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 07/08/2019] [Accepted: 07/08/2019] [Indexed: 12/17/2022]
Abstract
Objective Quantification of gait with wearable technology is promising; recent cross‐sectional studies showed that gait characteristics are potential prodromal markers for Parkinson disease (PD). The aim of this longitudinal prospective observational study was to establish gait impairments and trajectories in the prodromal phase of PD, identifying which gait characteristics are potentially early diagnostic markers of PD. Methods The 696 healthy controls (mean age = 63 ± 7 years) recruited in the Tubingen Evaluation of Risk Factors for Early Detection of Neurodegeneration study were included. Assessments were performed longitudinally 4 times at 2‐year intervals, and people who converted to PD were identified. Participants were asked to walk at different speeds under single and dual tasking, with a wearable device placed on the lower back; 14 validated clinically relevant gait characteristics were quantified. Cox regression was used to examine whether gait at first visit could predict time to PD conversion after controlling for age and sex. Random effects linear mixed models (RELMs) were used to establish longitudinal trajectories of gait and model the latency between impaired gait and PD diagnosis. Results Sixteen participants were diagnosed with PD on average 4.5 years after first visit (converters; PDC). Higher step time variability and asymmetry of all gait characteristics were associated with a shorter time to PD diagnosis. RELMs indicated that gait (lower pace) deviates from that of non‐PDC approximately 4 years prior to diagnosis. Interpretation Together with other prodromal markers, quantitative gait characteristics can play an important role in identifying prodromal PD and progression within this phase. ANN NEUROL 2019;86:357–367
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Affiliation(s)
- Silvia Del Din
- Institute of Neuroscience/Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Morad Elshehabi
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, University Hospital Tübingen, and Center for Neurodegenerative Diseases, Tübingen, Germany.,Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Brook Galna
- Institute of Neuroscience/Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK.,School of Biomedical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Markus A Hobert
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, University Hospital Tübingen, and Center for Neurodegenerative Diseases, Tübingen, Germany.,Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Elke Warmerdam
- Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Ulrike Suenkel
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, University Hospital Tübingen, and Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Kathrin Brockmann
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, University Hospital Tübingen, and Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Florian Metzger
- Geriatric Center and the Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Clint Hansen
- Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Daniela Berg
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, University Hospital Tübingen, and Center for Neurodegenerative Diseases, Tübingen, Germany.,Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Lynn Rochester
- Institute of Neuroscience/Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK.,Newcastle upon Tyne University Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, UK
| | - Walter Maetzler
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, University Hospital Tübingen, and Center for Neurodegenerative Diseases, Tübingen, Germany.,Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany
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Arcolin I, Corna S, Giardini M, Giordano A, Nardone A, Godi M. Proposal of a new conceptual gait model for patients with Parkinson's disease based on factor analysis. Biomed Eng Online 2019; 18:70. [PMID: 31159825 PMCID: PMC6547597 DOI: 10.1186/s12938-019-0689-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 05/27/2019] [Indexed: 12/20/2022] Open
Abstract
Background Gait impairment is a risk factor for falls in patients with Parkinson’s disease (PD). Gait can be conveniently assessed by electronic walkways, but there is need to select which spatiotemporal gait variables are useful for assessing gait in PD. Existing models for gait variables developed in healthy subjects and patients with PD show some methodological shortcomings in their validation through exploratory factor analysis (EFA), and were never confirmed by confirmatory factor analysis (CFA). The aims of this study were (1) to create a new model of gait for PD through EFA, (2) to analyze the factorial structure of our new model and compare it with existing models through CFA. Results From the 37 variables initially considered in 250 patients with PD, 10 did not show good-to-excellent reliability and were eliminated, while further 19 were eliminated after correlation matrix and Kaiser–Meyer–Olkin measure. The remaining eight variables underwent EFA and three factors emerged: pace/rhythm, variability, and asymmetry. Structural validity of our new model was then examined with CFA, using the structural equation modeling. After some modifications, suggested by the Modification Indices, we obtained a final model that showed an excellent fit. In contrast, when the structure of previous models of gait was analyzed, no model achieved convergence with our sample of patients. Conclusions Our model for spatiotemporal gait variables of patients with PD is the first to be developed through an accurate EFA and confirmed by CFA. It contains eight gait variables divided into three factors and shows an excellent fit. Reasons for the non-convergence of other models could be their inclusion of highly inter-correlated or low-reliability variables or could be possibly due to the fact that they did not use more recent methods for determining the number of factors to extract.
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Affiliation(s)
- Ilaria Arcolin
- Istituti Clinici Scientifici Maugeri Spa SB (IRCCS), Pavia, Italy
| | - Stefano Corna
- Istituti Clinici Scientifici Maugeri Spa SB (IRCCS), Pavia, Italy
| | - Marica Giardini
- Istituti Clinici Scientifici Maugeri Spa SB (IRCCS), Pavia, Italy.
| | - Andrea Giordano
- Istituti Clinici Scientifici Maugeri Spa SB (IRCCS), Pavia, Italy
| | - Antonio Nardone
- Istituti Clinici Scientifici Maugeri Spa SB (IRCCS), Pavia, Italy.,Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Marco Godi
- Istituti Clinici Scientifici Maugeri Spa SB (IRCCS), Pavia, Italy
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Wilson J, Allcock L, Mc Ardle R, Taylor JP, Rochester L. The neural correlates of discrete gait characteristics in ageing: A structured review. Neurosci Biobehav Rev 2019; 100:344-369. [PMID: 30552912 PMCID: PMC6565843 DOI: 10.1016/j.neubiorev.2018.12.017] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 11/01/2018] [Accepted: 12/12/2018] [Indexed: 11/03/2022]
Abstract
Gait is complex, described by diverse characteristics underpinned by widespread central nervous system networks including motor and cognitive functions. Despite this, neural substrates of discrete gait characteristics are poorly understood, limiting understanding of gait impairment in ageing and disease. This structured review aims to map gait characteristics, defined from a pre-specified model reflecting independent gait domains, to brain imaging parameters in older adults. Fifty-two studies of 38,029 yielded were reviewed. Studies showed inconsistent approaches when mapping gait assessment to neural substrates, limiting conclusions. Gait impairments typically associated with brain deterioration, specifically grey matter atrophy and white matter integrity loss. Gait velocity, a global measure of gait control, was most frequently associated with these imaging markers within frontal and basal ganglia regions, and its decline predicted from white matter volume and integrity measurements. Fewer studies assessed additional gait measures or functional imaging parameters. Future studies mapping regional neuroanatomical and functional correlates of gait are needed, including those which take a multi-process network perspective to better understand mobility in health and disease.
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Affiliation(s)
- Joanna Wilson
- Institute of Neuroscience, Newcastle University Institute of Ageing, Newcastle Upon Tyne, UK
| | - Liesl Allcock
- Geriatric Medicine, Northumbria Healthcare Trust, UK
| | - Ríona Mc Ardle
- Institute of Neuroscience, Newcastle University Institute of Ageing, Newcastle Upon Tyne, UK
| | - John-Paul Taylor
- Institute of Neuroscience, Newcastle University Institute of Ageing, Newcastle Upon Tyne, UK
| | - Lynn Rochester
- Institute of Neuroscience, Newcastle University Institute of Ageing, Newcastle Upon Tyne, UK; Newcastle Upon Tyne Hospital NHS Foundation Trust, UK.
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27
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Broom L, Worley A, Gao F, Hernandez LD, Ashton CE, Shih LC, VanderHorst VG. Translational methods to detect asymmetries in temporal and spatial walking metrics in parkinsonian mouse models and human subjects with Parkinson's disease. Sci Rep 2019; 9:2437. [PMID: 30792396 PMCID: PMC6385183 DOI: 10.1038/s41598-019-38623-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 12/21/2018] [Indexed: 12/31/2022] Open
Abstract
Clinical signs in Parkinson's disease (PD), including parkinsonian gait, are often asymmetric, but mechanisms underlying gait asymmetries in PD remain poorly understood. A translational toolkit, a set of standardized measures to capture gait asymmetries in relevant mouse models and patients, would greatly facilitate research efforts. We validated approaches to quantify asymmetries in placement and timing of limbs in mouse models of parkinsonism and human PD subjects at speeds that are relevant for human walking. In mice, we applied regression analysis to compare left and right gait metrics within a condition. To compare alternation ratios of left and right limbs before and after induction of parkinsonism, we used circular statistics. Both approaches revealed asymmetries in hind- and forelimb step length in a unilateral PD model, but not in bilateral or control models. In human subjects, a similar regression approach showed a step length asymmetry in the PD but not control group. Sub-analysis of cohorts with predominant postural instability-gait impairment and with predominant tremor revealed asymmetries for step length in both cohorts and for swing time only in the former cohort. This translational approach captures asymmetries of gait in mice and patients. Application revealed striking differences between models, and that spatial and temporal asymmetries may occur independently. This approach will be useful to investigate circuit mechanisms underlying the heterogeneity between models.
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Affiliation(s)
- Lauren Broom
- Department of Neurology, Division of Movement Disorders, Beth Israel Deaconess Medical Center and Harvard Medical School, 3 Blackfan Circle, Boston, MA, 02115, USA
| | - Audrey Worley
- Department of Neurology, Division of Movement Disorders, Beth Israel Deaconess Medical Center and Harvard Medical School, 3 Blackfan Circle, Boston, MA, 02115, USA
| | - Fay Gao
- Department of Neurology, Division of Movement Disorders, Beth Israel Deaconess Medical Center and Harvard Medical School, 3 Blackfan Circle, Boston, MA, 02115, USA
| | - Laura D Hernandez
- Department of Neurology, Division of Movement Disorders, Beth Israel Deaconess Medical Center and Harvard Medical School, 3 Blackfan Circle, Boston, MA, 02115, USA
| | - Christine E Ashton
- Department of Neurology, Division of Movement Disorders, Beth Israel Deaconess Medical Center and Harvard Medical School, 3 Blackfan Circle, Boston, MA, 02115, USA
| | - Ludy C Shih
- Department of Neurology, Division of Movement Disorders, Beth Israel Deaconess Medical Center and Harvard Medical School, 3 Blackfan Circle, Boston, MA, 02115, USA
| | - Veronique G VanderHorst
- Department of Neurology, Division of Movement Disorders, Beth Israel Deaconess Medical Center and Harvard Medical School, 3 Blackfan Circle, Boston, MA, 02115, USA.
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Levy-Tzedek S, Arbelle D, Forman D, Zlotnik Y. Improvement in upper-limb UPDRS motor scores following fast-paced arm exercise: A pilot study. Restor Neurol Neurosci 2018; 36:535-545. [PMID: 29889088 PMCID: PMC6087443 DOI: 10.3233/rnn-180818] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The symptoms of patients with Parkinson's disease (PD) have been shown to improve when they perform fast-paced rhythmic cycling movements with their lower limbs. OBJECTIVE Our goal in this pilot experiment was to test the feasibility and the benefits of a short exercise program involving fast-paced rhythmic movements of the upper limb for patients with PD. METHODS We used an experimental procedure that elicits large, fast-paced movements by the participants without the direct instructions to do so by the experimenter. Ten participants with PD (71.0±6.5 years old) performed a 50-min fast-paced rhythmic exercise of the upper limb after withdrawal from PD medication for at least 12 hours. RESULTS Participants improved their kinematic performance, in terms of accuracy and combined speed and amplitude (p < 0.02), as well as their upper-limb MDS-UPDRS motor scores (p = 0.023). CONCLUSIONS The results demonstrate the feasibility of using the described apparatus to perform an exercise session of approximately 50 min with both arms, and give a preliminary indication of the potential benefit of such an exercise program.
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Affiliation(s)
- Shelly Levy-Tzedek
- Department of Physical Therapy, Recanati School for Community Health Professions, Ben Gurion University of the Negev, Beer Sheva, Israel
- Zlotowski Center for Neuroscience, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Dan Arbelle
- Department of Physical Therapy, Recanati School for Community Health Professions, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Dan Forman
- Department of Physical Therapy, Recanati School for Community Health Professions, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Yair Zlotnik
- Department of Neurology, Soroka University Medical Center, Beer Sheva, Israel
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