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Baseline condition. Arm and thigh angles in the sagittal plane for each stride cycle of one representative control subject CO6 (A) and two representative Parkinson's disease patients PD3 (B) and PD7 (C). Lissajous graphs representing arm angle as a function of thigh angle for each stride cycle of one representative control subject CO6 (D) and two representative Parkinson's disease patients PD3 (E) and PD7 (F).
Source publication
Clinical evidence of impaired arm swing while walking in patients with Parkinson's disease suggests that basal ganglia and related systems play an important part in the control of upper limb locomotor automatism. To gain more information on this supraspinal influence, we measured arm and thigh kinematics during walking in 10 Parkinson's disease pat...
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Aims:
Although subthalamic nucleus deep brain stimulation (STN-DBS) is effective in patients with advanced Parkinson's disease (PD), its physiological mechanisms remain unclear. Because STN-DBS is effective in patients with PD whose motor symptoms are dramatically alleviated by L-3,4-dihydroxyphenylalanine (L-DOPA) treatment, the higher preoperati...
Alterations in temporal estimation have been observed in patients with Parkinson's disease (PD) and have been associated to dopaminergic dysfunction. Nevertheless, levodopa treatment and deep brain stimulation of the subthalamic nucleus (DBS-STN) have been shown to improve motor deficits and temporal estimation skills in such patients. So far, temp...
Citations
... 13 Furthermore, the striatum is known to influence proximal more than distal upper extremity segments, particularly the timing and coordination of shoulder and elbow movements. 14,15 Together, this body of research indicates that there are 2 different and distinctly organized motor systems, one for proximal and another for distal upper extremity motor control. This model would predict there should be different proximal vs distal expressions of focal CNS injury such as stroke, depending on the topography of injury and specific structures affected. ...
Background and Objectives
The classic and singular pattern of distal greater than proximal upper extremity motor deficits after acute stroke does not account for the distinct structural and functional organization of circuits for proximal and distal motor control in the healthy CNS. We hypothesized that separate proximal and distal upper extremity clinical syndromes after acute stroke could be distinguished, and that patterns of neuroanatomical injury leading to these two syndromes would reflect their distinct organization in the intact CNS.
Methods
Proximal and distal components of motor impairment (upper extremity Fugl-Meyer score) and strength (Shoulder Abduction Finger Extension score) were assessed in consecutively recruited patients within seven days of acute stroke. Partial correlation analysis was used to assess the relationship between proximal and distal motor scores. Functional outcomes including the Box & Blocks Test, Barthel Index, and modified Rankin Scale were examined in relation to proximal versus distal motor patterns of deficit. Voxel-based lesion-symptom mapping was used to identify regions of injury associated with proximal versus distal upper extremity motor deficits.
Results
A total of 141 consecutive patients (49% female) were assessed 4.0 ± 1.6 (mean ± SD) days after stroke onset. Separate proximal and distal upper extremity motor components were distinguishable after acute stroke (p = 0.002). A pattern of proximal more than distal injury (i.e., relatively preserved distal motor control) was not rare, observed in 23% of acute stroke subjects. Patients with relatively preserved distal motor control, even after controlling for total extent of deficit, had better outcomes in the first week and at 90-days post-stroke (Box and Block Test, ρ = 0.51, p < 0.001; Barthel Index, ρ = 0.41, p < 0.001; modified Rankin Scale, ρ = 0.38, p < 0.001). Deficits in proximal motor control were associated with widespread injury to subcortical white and gray matter, while deficits in distal motor control were associated with injury restricted to the posterior aspect of the precentral gyrus, consistent with the organization of proximal versus distal neural circuits in the healthy CNS.
Conclusions
These results highlight that proximal and distal upper extremity motor systems can be selectively injured by acute stroke, with dissociable deficits and functional consequences. Our findings emphasize how disruption of distinct motor systems can contribute to separable components of post-stroke upper extremity hemiparesis.
... Freezing of gait [5], festination [6], gait initiation [7] and termination deficits [8], poor dynamic balance [9,10], difficulty in negotiating turning [11], tremor [12], and upper limb locomotor synergies [13] are among the typical motor signs affecting persons with PD. More generally, PD impacts many aspects of daily life, including sleep and diet [14]. ...
(1) Background: A noticeable association between the motor activity (MA) profiles of persons living together has been found in previous studies. Social actigraphy methods have shown that this association, in marital dyads composed of healthy individuals, is greater than that of a single person compared to itself. This study aims at verifying the association of MA profiles in dyads where one component is affected by Parkinson’s disease (PD). (2) Methods: Using a wearable sensor-based social actigraphy approach, we continuously monitored, for 7 days, the activities of 27 marital dyads including one component with PD. (3) Results: The association of motor activity profiles within a marital dyad (cross-correlation coefficient 0.344) is comparable to the association of any participant with themselves (0.325). However, when considering the disease severity quantified by the UPDRS III score, it turns out that the less severe the symptoms, the more associated are the MA profiles. (4) Conclusions: Our findings suggest that PD treatment could be improved by leveraging the MA of the healthy spouse, thus promoting lifestyles also beneficial for the component affected by PD. The actigraphy approach provided valuable information on habitual functions and motor fluctuations, and could be useful in investigating the response to treatment.
... 17 Basal ganglia (BG) play a critical role in the automaticity of motor control, including upper limb motor control. 18 Hence, patients with PD experienced decreased automaticity of motor control caused by diseased BG (i.e., de-automatization) and, as a compensatory mechanism, they tend to use attentional/conscious control strategy. 19 This implies that these patients allocate greater attentional resources for doing each motor task, leading to enhanced impairments of motor function if their attention is withdrawn from an ongoing motor task to another one (e.g., under dual-task condition). ...
Freezing of gait (FOG) is a debilitating symptom in patients with Parkinson's disease (PD), which may be associated with motor control impairments in tasks other than gait. This study aimed to examine whether symmetric and asymmetric bimanual coordination is impaired in PD with FOG (PD +FOG) patients and whether dual‐task and drug phases may affect bimanual coordination in these patients. Twenty PD +FOG patients, 20 PD patients without FOG (PD –FOG) performed symmetric and asymmetric functional bimanual tasks (reach to and pick up a box and open a drawer to press a pushbutton inside it, respectively) under single‐task and dual‐task conditions. PD patients were evaluated during on‐ and off‐drug phases. Kinematic and coordination measures were calculated for each task. PD +FOG patients demonstrated exacerbated impairments of bimanual coordination while performing goal‐directed bimanual tasks, which was more evident in the asymmetric bimanual task and under dual‐task conditions, highlighting the need for rehabilitation interventions for bimanual tasks that include different cognitive loads in these patients. Interestingly, 25% and 5% of participants in the PD +FOG and –FOG groups developed upper limb freezing 2 years later, respectively. This study aimed to examine whether symmetric and asymmetric bimanual coordination is impaired in Parkinson's disease with freezing of gait (PD +FOG) patients and whether dual‐task and drug phases may affect bimanual coordination in these patients. PD +FOG patients demonstrated exacerbated impairment of bimanual coordination while performing goal‐directed bimanual tasks, highlighting the need for rehabilitation interventions for bimanual tasks that include different cognitive loads in these patients.
... The changes in main arm swing amplitude, peak angular velocity, and coordination with medication at preferred speed corresponds with other studies investigating gait aspects in Parkinson's disease 5,16,30 . In previous studies, looking at gait parameters, it has been seen that mainly the amplitude-and velocity-based measures (step length, gait velocity, step velocity) improved with medication at preferred speed, which is comparable to our results 2,5-7,10 . ...
The evidence of the responsiveness of dopaminergic medication on gait in patients with Parkinson’s disease is contradicting. This could be due to differences in complexity of the context gait was in performed. This study analysed the effect of dopaminergic medication on arm swing, an important movement during walking, in different contexts. Forty-five patients with Parkinson’s disease were measured when walking at preferred speed, fast speed, and dual-tasking conditions in both OFF and ON medication states. At preferred, and even more at fast speed, arm swing improved with medication. However, during dual-tasking, there were only small or even negative effects of medication on arm swing. Assuming that dual-task walking most closely reflects real-life situations, the results suggest that the effect of dopaminergic medication on mobility-relevant movements, such as arm swing, might be small in everyday conditions. This should motivate further studies to look at medication effects on mobility in Parkinson’s disease, as it could have highly relevant implications for Parkinson’s disease treatment and counselling.
... Firstly, there is a potential role of AS for gait stability and, in this sense, reduced AS has been associated with an increased risk of falls in PD 8 . Secondly, reduced AS during gait appears to be less responsive to dopaminergic medication and deep brain stimulation than leg movements 9 . ...
Background:
Reduction of arm swing during gait is an early and common symptom in Parkinson's disease (PD). By using the technology of a mobile phone, acceleration of arm swing can be converted into a closed-loop musical feedback (musification) to improve gait.
Objectives:
To assess arm swing in healthy subjects and the effects of musification on arm swing amplitude and other gait parameters in patients with PD.
Methods:
Gait kinematics were analyzed in 30 patients during a 320 m walk in 3 different conditions comprising (1) normal walking; (2) focused swinging of the more affected arm; and (3) with musification of arm swing provided by the iPhone application CuraSwing. The acceleration of arm swing was converted into musical feedback. Arm swing range of motion and further gait kinematics were analyzed. In addition, arm swing in patients was compared to 32 healthy subjects walking at normal, slow, and fast speeds.
Results:
Musification led to a large and bilateral increase of arm swing range of motion in patients. The increase was greater on the more affected side of the patient (+529.5% compared to baseline). In addition, symmetry of arm swing, sternum rotation, and stride length increased. With musical feedback patients with PD reached arm swing movements within or above the range of healthy subjects.
Conclusions:
Musification has an immediate effect on arm swing and other gait kinematics in PD. The results suggest that closed-loop musical feedback is an effective technique to improve walking in patients with PD.
... However, it is also possible to observe non-functional periodic movements such as tremor [3] or some cyclic gestures related to dystonic syndromes [4]. The periodicity of human locomotion is normally automatic and not necessarily consciously planned, controlled, and performed since specific neural structures, the central pattern generators, are in charge of controlling locomotor movements [5]. Moreover, inherent passive biomechanical and inertial characteristics of the different body parts naturally support the occurrence of passive pendulum-like periodic movements [6]. ...
The regularity of pseudo-periodic human movements, including locomotion, can be assessed by autocorrelation analysis of measurements using inertial sensors. Though sensors are generally placed on the trunk or pelvis, movement regularity can be assessed at any body location. Pathological factors are expected to reduce regularity either globally or on specific anatomical subparts. However, other non-pathological factors, including gait strategy (walking and running) and speed, modulate locomotion regularity, thus potentially confounding the identification of the pathological factor. The present study’s objectives were (1) to define a multi-sensor method based on the autocorrelation analysis of the acceleration module (norm of the acceleration vector) to quantify regularity; (2) to conduct an experimental study on healthy adult subjects to quantify the effect on movement regularity of gait strategy (walking and running at the same velocity), gait speed (four speeds, lower three for walking, upper two for running), and sensor location (on four different body parts). Twenty-five healthy adults participated and four triaxial accelerometers were located on the seventh cervical vertebra (C7), pelvis, wrist, and ankle. The results showed that increasing velocity was associated with increasing regularity only for walking, while no difference in regularity was observed between walking and running. Regularity was generally highest at C7 and ankle, and lowest at the wrist. These data confirm and complement previous literature on regularity assessed on the trunk, and will support future analyses on individuals or groups with specific pathologies affecting locomotor functions.
... eine höhere Asymmetrie während des Armschwungs aufweisen (Huang et al., 2012). Ergebnissen (Carpinella et al., 2007;Crenna et al., 2008;Sterling et al., 2015). Darüber hinaus haben verschiedene Studien gezeigt, dass die reduzierte Armbewegung während des Gehens unter Therapie mit LD (Sterling et al., 2015) bzw. ...
... Darüber hinaus haben verschiedene Studien gezeigt, dass die reduzierte Armbewegung während des Gehens unter Therapie mit LD (Sterling et al., 2015) bzw. durch die Kombination aus dopaminerger Medikation und bilateraler STN-THS positiv moduliert werden kann (Carpinella et al., 2007;Crenna et al., 2008). ...
... Dies wird als vermindertes Mitschwingen bezeichnet (Nieuwboer et al., 1998 Armbewegung während des Gehens unter Therapie mit LD (Sterling et al., 2015) bzw. durch die Kombination aus dopaminerger Medikation und bilateraler STN-THS positiv moduliert werden kann (Carpinella et al., 2007;Crenna et al., 2008 ...
In der vorliegenden Arbeit wurde das motorische Verhalten von Patienten mit idiopathischem Parkinson-Syndrom (PD) im Off und unter Therapie mit Tiefenhirnstimulation (THS) und Medikation im Vergleich zu einer Kontrollgruppe untersucht. Dazu wurde die Motorik über verschiedene Bewegungsklassen mittels eines Sensoranzuges mit 17 inertialen Messeinheiten aufgezeichnet und anhand ausgewählter Parameter und Segmente analysiert. Darüber hinaus wurde bei einer PD-Kohorte mit diesem Ansatz erstmals der Effekt verschiedener THS-Parametereinstellungen untersucht. Neben einigen klinischen Parametern wurde die mittlere Magnitude der absoluten 3D-Vektoren von Geschwindigkeit, Beschleunigung und Jerk als Funktion der Segmente der oberen Extremität während des Ganges und einer funktionellen Armbewegung herangezogen. Zudem wurde das Verhalten von 7 Körpersegmenten entlang der Longitudinalachse anhand der genannten Parameter während der Instrumentierung des Timed Up and Go (TUG) und Functional Reach (FR) analysiert.
Die Ergebnisse bestätigten das hypo- und bradykinetische Gangmuster bei PD mit verlängerter Schrittdauer, reduzierter Schrittlänge und Ganggeschwindigkeit bei erhöhter Gangvariabilität. Dieses besserte sich unter Therapie signifikant bei gleichzeitig persistierenden Defiziten. Die Armbewegung war reduziert und in der segmentalen Skalierung für einige Parameter gestört. Das Ansprechen der defizitären Armbewegung auf die Therapie variierte abhängig von Parameter und Bewegungssequenz. Auffallend waren erhöhte Jerks in den distalen Segmenten der therapierten Patienten. Die Instrumentierung des TUG und FR bestätigte die defizitäre dynamische Balance, die eingeschränkte Mobilität sowie die reduzierten Grenzen der funktionellen Balance bei PD. Diese verbesserten sich unter Therapie. Zudem offenbarte die Analyse, dass die Skalierung von Geschwindigkeit, Beschleunigung und Jerk bei PD Patienten entlang der Longitudinalachse während des TUG und FR abhängig von Parameter und Bewegungssequenz verändert ist, aber teilweise auch eine physiologische Bewegungsstrategie gewählt wird. Hinsichtlich der veränderten Parametereinstellung zeigte sich, dass die Reduktion der Amplitude bei gegensinniger Kalibrierung der Pulsweite insgesamt mit einer signifikanten Verschlechterung der analysierten Parameter verbunden war und die Motorik sich dabei tendenziell in Richtung von nicht-therapierten PD Patienten bewegte.
Bereits anhand einfacher Parameter wie mittlerer Geschwindigkeit, Beschleunigung und Jerk im 3D-Raum lassen sich motorische Veränderungen identifizieren und beschreiben, welche durch klinische Tests nicht erfassbar sind. Die Sensor-basierte Bewegungserfassung bietet somit das Potential, neben der Erforschung von motorischen Veränderungen bei PD auch die Diagnostik und das Monitoring im Krankheitsverlauf bzw. die Evaluation von therapeutischen Interventionen von Bewegungsstörungen zu verbessern. Bewegungsbasierte Kontrollparameter könnten zudem für die Entwicklung von adaptiven THS-Systemen herangezogen werden.
... However, this difference disappeared when subjects using rails were excluded. A first hypothesis could be the detrimental effect of upper limb bradykinesia and reduced arm/leg coordination [46], that could be more pronounced when subjects interact with the rail to ascend stairs. A second hypothesis, could be the better dynamic balance and the lower severity of PD subjects not using handrails, as noticed by the higher mDGI score (+14 points) and by the larger number of patients (3 versus 1) in the mild stage of the disease (H &Y <= 2.5). ...
Stair ascent is a challenging daily-life activity highly related to independence. This task is usually assessed with clinical scales suffering from partial subjectivity and limited detail in evaluating different task’s aspects. In this study we instrumented the assessment of stair ascent in people with Multiple Sclerosis (MS), stroke (ST) and Parkinson’s disease (PD) to analyze the validity of the proposed quantitative indexes and characterize subjects’ performances. Participants climbed 10 steps wearing a magneto-inertial sensor (MIMU) at sternum level. Gait pattern features (step frequency, symmetry, regularity, harmonic ratios), and upper trunk sway were computed from MIMU signals. Clinical mDGI (modified Dynamic Gait Index) and mDGI-Item 8 (“Up stairs”) were administered. Significant correlations with clinical scores were found for gait pattern features (rs>=0.536) and trunk pitch sway (rs<=-0.367) demonstrating their validity. Instrumental indexes showed alterations in the three pathological groups compared to healthy subjects, and significant differences, not clinically detected, among MS, ST and PD. MS showed the worst performance, with alterations of all gait pattern aspects and larger trunk pitch sway. ST showed worsening in gait pattern features, but not in trunk motion. PD showed fewer alterations consisting in reduced step frequency and trunk yaw sway. These results suggest that the use of a MIMU provided valid objective indexes revealing between-group differences in stair ascent not detected by clinical scales. Importantly, the indexes includes upper trunk measures, usually not present in clinical tests, and provides relevant hints for tailored rehabilitation.
... Bilateral STN-DBS has been demonstrated as an effective treatment for advanced PD patients both in the short and in the long term, leading to a good control of all the PD cardinal symptoms (rigidity, bradykinesia, and tremor) and of the drug-induced motor complications (motor fluctuations and dyskinesias) (1)(2)(3)(4)(5)(6)(7). Moreover, studies performed with instrumented movement analysis showed the significant improvements provided by bilateral STN-DBS on anticipatory postural adjustments before gait initiation (8), kinematics and kinetics of lower limb joints during steady-state walking (9), and upper limb locomotor synergies (10), that are commonly affected in the advanced stage of PD. Even though bilateral STN-DBS is considered a relatively safe procedure, in the last years there has been a growing interest in unilateral and staged STN-DBS (i.e., implant of the two electrodes during two distinct surgical sittings separated over time), which involves lower surgical risk and less post-operative complications, such as cognitive dysfunctions (11)(12)(13)(14). ...
Background
It has been suggested that parkinsonian [Parkinson’s disease (PD)] patients might have a “dominant” (DOM) subthalamic nucleus (STN), whose unilateral electrical stimulation [deep brain stimulation (DBS)] could lead to an improvement in PD symptoms similar to bilateral STN-DBS.
Objectives
Since disability in PD patients is often related to gait problems, in this study, we wanted to investigate in a group of patients bilaterally implanted for STN-DBS: (1) if it was possible to identify a subgroup of subjects with a dominant STN; (2) in the case, if the unilateral stimulation of the dominant STN was capable to improve gait abnormalities, as assessed by instrumented multifactorial gait analysis, similarly to what observed with bilateral stimulation.
Methods
We studied 10 PD patients with bilateral STN-DBS. A clinical evaluation and a kinematic, kinetic, and electromyographic (EMG) analysis of overground walking were performed—off medication—in four conditions: without stimulation, with bilateral stimulation, with unilateral right or left STN-DBS. Through a hierarchical agglomerative cluster analysis based on motor Unified Parkinson’s Disease Rating Scale scores, it was possible to separate patients into two groups, based on the presence (six patients, DOM group) or absence (four patients, NDOM group) of a dominant STN.
Results
In the DOM group, both bilateral and unilateral stimulation of the dominant STN significantly increased gait speed, stride length, range of motion of lower limb joints, and peaks of moment and power at the ankle joint; moreover, the EMG activation pattern of distal leg muscles was improved. The unilateral stimulation of the non-dominant STN did not produce any significant effect. In the NDOM group, only bilateral stimulation determined a significant improvement of gait parameters.
Conclusion
In the DOM group, the effect of unilateral stimulation of the dominant STN determined an improvement of gait parameters similar to bilateral stimulation. The pre-surgical identification of these patients, if possible, could allow to reduce the surgical risks and side effects of DBS adopting a unilateral approach.
... However, this difference disappeared when subjects using rails were excluded. A first hypothesis could be the detrimental effect of upper limb bradykinesia and reduced arm/leg coordination [46], that could be more pronounced when subjects interact with the rail to ascend stairs. A second hypothesis, could be the better dynamic balance and the lower severity of PD subjects not using handrails, as noticed by the higher mDGI score (+14 points) and by the larger number of patients (3 versus 1) in the mild stage of the disease (H &Y <= 2.5). ...
