Relationship between Sensorimotor Inhibition and Mobility in Older Adults with and without Parkinson’s Disease

Abstract Background Reduced cortical sensorimotor inhibition is associated with mobility and cognitive impairments in people with Parkinson’s disease (PD) and older adults (OAs). However, there is a lack of clarity regarding the relationships among sensorimotor, cognitive, and mobility impairments. The purpose of this study was to determine how cortical sensorimotor inhibition relates to impairments in mobility and cognition in people with PD and OAs. Methods Cortical sensorimotor inhibition was characterized with short-latency afferent inhibition (SAI) in 81 people with PD and 69 OAs. Six inertial sensors recorded single- and dual-task gait and postural sway characteristics during a two-minute walk and a one-minute quiet stance. Cognition was assessed across the memory, visuospatial, executive function, attention, and language domains. Results SAI was significantly impaired in the PD compared to the OA group. The PD group preformed significantly worse across all gait and postural sway tasks. In PD, SAI significantly correlated with single-task foot strike angle and stride length variability, sway area, and jerkiness of sway in the coronal and sagittal planes. In OAs, SAI significantly related to single-task gait speed and stride length, dual-task stride length, and immediate recall (memory domain). No relationship among mobility, cognition, and SAI was observed. Conclusions Impaired SAI related to slower gait in OA and to increased gait variability and postural sway in people with PD, all of which have been shown to be related to increased fall risk.

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Digital Biomarkers of Cognitive Frailty: The Value of Detailed Gait Assessment Beyond Gait Speed

Gerontology ◽

10.1159/000515939 ◽

2021 ◽

pp. 1-10

Author(s):

He Zhou ◽

Catherine Park ◽

Mohammad Shahbazi ◽

Michele K. York ◽

Mark E. Kunik ◽

...

Keyword(s):

Older Adults ◽

Steady State ◽

Dual Task ◽

Gait Speed ◽

Stride Length ◽

Cognitive Frailty ◽

Single Task ◽

Double Support ◽

Gait Parameters ◽

Digital Biomarkers

Background: Cognitive frailty (CF), defined as the simultaneous presence of cognitive impairment and physical frailty, is a clinical symptom in early-stage dementia with promise in assessing the risk of dementia. The purpose of this study was to use wearables to determine the most sensitive digital gait biomarkers to identify CF. Methods: Of 121 older adults (age = 78.9 ± 8.2 years, body mass index = 26.6 ± 5.5 kg/m2) who were evaluated with a comprehensive neurological exam and the Fried frailty criteria, 41 participants (34%) were identified with CF and 80 participants (66%) were identified without CF. Gait performance of participants was assessed under single task (walking without cognitive distraction) and dual task (walking while counting backward from a random number) using a validated wearable platform. Participants walked at habitual speed over a distance of 10 m. A validated algorithm was used to determine steady-state walking. Gait parameters of interest include steady-state gait speed, stride length, gait cycle time, double support, and gait unsteadiness. In addition, speed and stride length were normalized by height. Results: Our results suggest that compared to the group without CF, the CF group had deteriorated gait performances in both single-task and dual-task walking (Cohen’s effect size d = 0.42–0.97, p < 0.050). The largest effect size was observed in normalized dual-task gait speed (d = 0.97, p < 0.001). The use of dual-task gait speed improved the area under the curve (AUC) to distinguish CF cases to 0.76 from 0.73 observed for the single-task gait speed. Adding both single-task and dual-task gait speeds did not noticeably change AUC. However, when additional gait parameters such as gait unsteadiness, stride length, and double support were included in the model, AUC was improved to 0.87. Conclusions: This study suggests that gait performances measured by wearable sensors are potential digital biomarkers of CF among older adults. Dual-task gait and other detailed gait metrics provide value for identifying CF above gait speed alone. Future studies need to examine the potential benefits of gait performances for early diagnosis of CF and/or tracking its severity over time.

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Effects of Simulated Horseback Riding on Balance, Postural Sway, and Quality of Life in Older Adults With Parkinson’s Disease

Adapted Physical Activity Quarterly ◽

10.1123/apaq.2019-0008 ◽

2019 ◽

Vol 36 (4) ◽

pp. 413-430 ◽

Cited By ~ 2

Author(s):

Leah S. Goudy ◽

Brandon Rhett Rigby ◽

Lisa Silliman-French ◽

Kevin A. Becker

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Cognitive Impairment ◽

Postural Sway ◽

Berg Balance Scale ◽

Horseback Riding ◽

Scale Scores

The purpose of this study was to determine changes in balance, postural sway, and quality of life after 6 wk of simulated horseback riding in adults diagnosed with Parkinson’s disease. Eight older adults completed two 60-min riding sessions weekly for 6 wk. Variables of balance, postural sway, and quality of life were measured 6 wks before and within 1 wk before and after the intervention. Berg Balance Scale scores decreased from baseline to preintervention (48.36 ± 5.97 vs. 45.86 ± 6.42,p = .050) and increased from preintervention to postintervention (45.86 ± 6.42 vs. 50.00 ± 4.38,p = .002). Cognitive impairment, a dimension of quality of life, improved from baseline to postintervention (37.5 ± 20.5 vs. 21.5 ± 14.4,p = .007). Six weeks of simulated horseback riding may improve balance and cognitive impairment in older adults with Parkinson’s disease.

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A Comparison of Physical Activity and Dual Task Gait Among Persons with Parkinson's Disease and Healthy Older Adults

Physical & Occupational Therapy In Geriatrics ◽

10.3109/02703181.2015.1134747 ◽

2016 ◽

Vol 34 (2-3) ◽

pp. 113-123 ◽

Cited By ~ 1

Author(s):

Chad Swank ◽

Elaine Trudelle-Jackson ◽

Ann Medley ◽

Mary Thompson ◽

Allen Jackson

Keyword(s):

Physical Activity ◽

Older Adults ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Dual Task ◽

Healthy Older Adults

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Different types of additional somatosensory information do not promote immediate benefits on gait in patients with Parkinson's disease and older adults

Motriz Revista de Educação Física ◽

10.1590/s1980-65742015000300004 ◽

2015 ◽

Vol 21 (3) ◽

pp. 244-249

Author(s):

Ellen Lirani-Silva ◽

Rodrigo Vitório ◽

Fabio Augusto Barbieri ◽

André Macari Baptista ◽

Paulo Cezar Rocha dos Santos ◽

...

Keyword(s):

Older Adults ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Stride Length ◽

Cutaneous Stimulation ◽

Healthy Older Adults ◽

Somatosensory Information ◽

Different Types ◽

Before And After

AbstractPlantar cutaneous stimulation has been shown to improve gait in Parkinson's disease (PD), but the effects of different types of insoles have not been tested. We evaluated the immediate effect of different types of insoles on gait in PD patients and healthy older adults. Nineteen PD patients and nineteen healthy older adults performed and performed a walking task at their self-selected speed in three conditions: conventional insole, insole with a raised ridge around the foot perimeter, and insole with half-spheres. Plantar sensation was evaluated before and after the walking protocol. There were no differences between groups for plantar sensation before and after the walking task. PD patients demonstrated reduced stride length and stride velocity. There were no immediate benefits offered by the insoles on gait of either group. The increased plantar cutaneous stimulation does not promote immediate benefits on gait in PD patients and healthy older adults.

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A Novel Easy-of-Use Smartphone-Based Assessment of Gait Characteristics in Parkinson’s Disease (Preprint)

10.2196/preprints.25451 ◽

2020 ◽

Author(s):

Dongning Su ◽

Zhu Liu ◽

Xin Jiang ◽

Fangzhao Zhang ◽

Wanting Yu ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Dual Task ◽

Gold Standard ◽

Rating Scale ◽

Standard System ◽

Functional Characteristics ◽

Velocity Signal ◽

Single Task ◽

Gait Assessment

BACKGROUND Parkinson’s disease (PD) is common movement disorder and patients with PD had multiple gait impairments, leading to increased risk of falls, and diminished quality of life. The gait measurement in patients with Parkinson’s disease (PD) is thus important for the management of PD. OBJECTIVE We have developed and validated a smartphone-based assessment of gait, allowing the remote gait assessment in healthy cohorts. We here aimed to test the validity of this App-based gait measurement in people with PD and explore the association between the gait metrics measured by App and the clinical and functional characteristics in PD. METHODS Fifty-two participants with clinically-diagnosed PD completed assessments of walking, MDS-Unified Parkinson's Disease Rating Scale III (UPDRS III), Montreal Cognitive Assessment (MoCA), Hamilton Anxiety (HAM-A) and Depression (HAM-D) rating scale tests. Participants followed multi-media instructions provided by the App to complete two 20-meter trials each of walking normally (single-task) and walking while performing a serial subtraction dual task (dual-task). The locomotion data were simultaneously collected with the App and a gold-standard system. The gait stride times (ST) and stride time variability (STV) were derived from the acceleration and angular velocity signal acquired from the internal motion sensor of the phone, and from the wearable sensor system. RESULTS High correlations between the ST and STV derived from the App and those from gold-standard system were observed (r=0.98~0.99, p<.0001), revealing excellent validity of the App-based gait assessment in PD. Compared to single-task, the ST (F=13.1, p=.0005) and STV (F=6.3, p=.01) in dual-task condition were significantly greater. Participants with greater STV in both conditions had greater total score of UPDRS III (r=0.37~0.39, p=.0007~.01), HAM-A (single-task: r=0.49, p=.007; dual-task: r=0.48, p=.009) and HAM-D (single-task: r=0.44, p=.01; dual-task: r=0.49, p=.009); and those with greater dual-task STV (r=0.48, p=.001) and/or dual-task cost to STV (r=0.44, p=.004) had lower MoCA score. CONCLUSIONS These results demonstrated that this ease-of-its-use smartphone-based gait measurement is validated and provides meaningful metrics that are associated with clinical and functional characteristics in PD.

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Dual task interference on postural sway, postural transitions and gait in people with Parkinson’s disease and freezing of gait

Gait & Posture ◽

10.1016/j.gaitpost.2017.05.006 ◽

2017 ◽

Vol 56 ◽

pp. 76-81 ◽

Cited By ~ 49

Author(s):

Ana Claudia de Souza Fortaleza ◽

Martina Mancini ◽

Patty Carlson-Kuhta ◽

Laurie A. King ◽

John G. Nutt ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Dual Task ◽

Postural Sway ◽

Freezing Of Gait ◽

Task Interference ◽

Dual Task Interference

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Executive Control of Walking in People With Parkinson’s Disease With Freezing of Gait

Neurorehabilitation and Neural Repair ◽

10.1177/1545968320969940 ◽

2020 ◽

Vol 34 (12) ◽

pp. 1138-1149

Author(s):

Rodrigo Vitorio ◽

Samuel Stuart ◽

Martina Mancini

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Executive Control ◽

Dual Task ◽

Near Infrared ◽

Inertial Sensors ◽

Cognitive Task ◽

Freezing Of Gait ◽

Functional Near Infrared Spectroscopy ◽

Indirect Measures

Background Walking abnormalities in people with Parkinson’s disease (PD) are characterized by a shift in locomotor control from healthy automaticity to compensatory prefrontal executive control. Indirect measures of automaticity of walking (eg, step-to-step variability and dual-task cost) suggest that freezing of gait (FoG) may be associated with reduced automaticity of walking. However, the influence of FoG status on actual prefrontal cortex (PFC) activity during walking remains unclear. Objective To investigate the influence of FoG status on automaticity of walking in people with PD. Methods Forty-seven people with PD were distributed into 2 groups based on FoG status, which was assessed by the New Freezing of Gait Questionnaire: PD−FoG (n = 23; UPDRS-III = 35) and PD+FoG (n = 24; UPDRS-III = 43.1). Participants walked over a 9-m straight path (with a 180° turn at each end) for 80 seconds. Two conditions were tested off medication: single- and dual-task walking (ie, with a concomitant cognitive task). A portable functional near-infrared spectroscopy system recorded PFC activity while walking (including turns). Wearable inertial sensors were used to calculate spatiotemporal gait parameters. Results PD+FoG had greater PFC activation during both single and dual-task walking than PD−FoG ( P = .031). There were no differences in gait between PD−FoG and PD+FoG. Both groups decreased gait speed ( P = .029) and stride length ( P < .001) during dual-task walking compared with single-task walking. Conclusions These findings suggest that PD+FoG have reduced automaticity of walking, even in absence of FoG episodes. PFC activity while walking seems to be more sensitive than gait measures in identifying reduction in automaticity of walking in PD+FoG.

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Measurement of Step Angle for Quantifying the Gait Impairment of Parkinson’s Disease by Wearable Sensors: Controlled Study (Preprint)

10.2196/preprints.16650 ◽

2019 ◽

Author(s):

Jingying Wang ◽

Dawei Gong ◽

Huichun Luo ◽

Wenbin Zhang ◽

Lei Zhang ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Dual Task ◽

Rating Scale ◽

Wearable Sensors ◽

Challenge Test ◽

Initial Step ◽

Controlled Study ◽

Walking Test ◽

Single Task

BACKGROUND Gait impairments including shuffling gait and hesitation are common in people with Parkinson’s disease (PD), and have been linked to increased fall risk and freezing of gait. Nowadays the gait metrics mostly focus on the spatiotemporal characteristics of gait, but less is known of the angular characteristics of the gait, which may provide helpful information pertaining to the functional status and effects of the treatment in PD. OBJECTIVE This study aimed to quantify the angles of steps during walking, and explore if this novel step angle metric is associated with the severity of PD and the effects of the treatment including the acute levodopa challenge test (ALCT) and deep brain stimulation (DBS). METHODS A total of 18 participants with PD completed the walking test before and after the ALCT, and 25 participants with PD completed the test with the DBS on and off. The walking test was implemented under two conditions: walking normally at a preferred speed (single task) and walking while performing a cognitive serial subtraction task (dual task). A total of 17 age-matched participants without PD also completed this walking test. The angular velocity was measured using wearable sensors on each ankle, and three gait angular metrics were obtained, that is mean step angle, initial step angle, and last step angle. The conventional gait metrics (ie, step time and step number) were also calculated. RESULTS The results showed that compared to the control, the following three step angle metrics were significantly smaller in those with PD: mean step angle (F1,48=69.75, P<.001, partial eta-square=0.59), initial step angle (F1,48=15.56, P<.001, partial eta-square=0.25), and last step angle (F1,48=61.99, P<.001, partial eta-square=0.56). Within the PD cohort, both the ALCT and DBS induced greater mean step angles (ACLT: F1,38=5.77, P=.02, partial eta-square=0.13; DBS: F1,52=8.53, P=.005, partial eta-square=0.14) and last step angles (ACLT: F1,38=10, P=.003, partial eta-square=0.21; DBS: F1,52=4.96, P=.003, partial eta-square=0.09), but no significant changes were observed in step time and number after the treatments. Additionally, these step angles were correlated with the Unified Parkinson's Disease Rating Scale, Part III score: mean step angle (single task: r=–0.60, P<.001; dual task: r=–0.52, P<.001), initial step angle (single task: r=–0.35, P=.006; dual task: r=–0.35, P=.01), and last step angle (single task: r=–0.43, P=.001; dual task: r=–0.41, P=.002). CONCLUSIONS This pilot study demonstrated that the gait angular characteristics, as quantified by the step angles, were sensitive to the disease severity of PD and, more importantly, can capture the effects of treatments on the gait, while the traditional metrics cannot. This indicates that these metrics may serve as novel markers to help the assessment of gait in those with PD as well as the rehabilitation of this vulnerable cohort.

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Repeated Gait Perturbation Training in Parkinson's Disease and Healthy Older Adults: A Systematic Review and Meta-Analysis

Frontiers in Human Neuroscience ◽

10.3389/fnhum.2021.732648 ◽

2021 ◽

Vol 15 ◽

Author(s):

Femke Hulzinga ◽

Veerle de Rond ◽

Britt Vandendoorent ◽

Moran Gilat ◽

Pieter Ginis ◽

...

Keyword(s):

Systematic Review ◽

Older Adults ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Gait Speed ◽

Stride Length ◽

Meta Analysis ◽

Gait Training ◽

Healthy Older Adults ◽

Perturbation Training

Background: Gait impairments are common in healthy older adults (HOA) and people with Parkinson's disease (PwPD), especially when adaptations to the environment are required. Traditional rehabilitation programs do not typically address these adaptive gait demands in contrast to repeated gait perturbation training (RGPT). RGPT is a novel reactive form of gait training with potential for both short and long-term consolidation in HOA and PwPD. The aim of this systematic review with meta-analysis is to determine whether RGPT is more effective than non-RGPT gait training in improving gait and balance in HOA and PwPD in the short and longer term.Methods: This review was conducted according to the PRISMA-guidelines and pre-registered in the PROSPERO database (CRD42020183273). Included studies tested the effects of any form of repeated perturbations during gait in HOA and PwPD on gait speed, step or stride length. Studies using balance scales or sway measures as outcomes were included in a secondary analysis. Effects of randomized controlled trials (RCT) on RGPT were pooled using a meta-analysis of final measures.Results: Of the 4421 studies, eight studies were deemed eligible for review, of which six could be included in the meta-analysis, totaling 209 participants (159 PwPD and 50 HOA). The studies were all of moderate quality. The meta-analysis revealed no significant effects of RGPT over non-RGPT training on gait performance (SMD = 0.16; 95% CI = −0.18, 0.49; Z = 0.92; P = 0.36). Yet, in some individual studies, favorable effects on gait speed, step length and stride length were observed immediately after the intervention as well as after a retention period. Gait variability and asymmetry, signifying more direct outcomes of gait adaptation, also indicated favorable RGPT effects in some individual studies.Conclusion: Despite some promising results, the pooled effects of RGPT on gait and balance were not significantly greater as compared to non-RGPT gait training in PwPD and HOA. However, these findings could have been driven by low statistical power. Therefore, the present review points to the imperative to conduct sufficiently powered RCT's to verify the true effects of RGPT on gait and balance in HOA and PwPD.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php? Identifier: CRD42020183273.

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Measurement of Step Angle for Quantifying the Gait Impairment of Parkinson’s Disease by Wearable Sensors: Controlled Study

JMIR mhealth and uhealth ◽

10.2196/16650 ◽

2020 ◽

Vol 8 (3) ◽

pp. e16650

Author(s):

Jingying Wang ◽

Dawei Gong ◽

Huichun Luo ◽

Wenbin Zhang ◽

Lei Zhang ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Dual Task ◽

Rating Scale ◽

Wearable Sensors ◽

Challenge Test ◽

Initial Step ◽

Controlled Study ◽

Walking Test ◽

Single Task

Background Gait impairments including shuffling gait and hesitation are common in people with Parkinson’s disease (PD), and have been linked to increased fall risk and freezing of gait. Nowadays the gait metrics mostly focus on the spatiotemporal characteristics of gait, but less is known of the angular characteristics of the gait, which may provide helpful information pertaining to the functional status and effects of the treatment in PD. Objective This study aimed to quantify the angles of steps during walking, and explore if this novel step angle metric is associated with the severity of PD and the effects of the treatment including the acute levodopa challenge test (ALCT) and deep brain stimulation (DBS). Methods A total of 18 participants with PD completed the walking test before and after the ALCT, and 25 participants with PD completed the test with the DBS on and off. The walking test was implemented under two conditions: walking normally at a preferred speed (single task) and walking while performing a cognitive serial subtraction task (dual task). A total of 17 age-matched participants without PD also completed this walking test. The angular velocity was measured using wearable sensors on each ankle, and three gait angular metrics were obtained, that is mean step angle, initial step angle, and last step angle. The conventional gait metrics (ie, step time and step number) were also calculated. Results The results showed that compared to the control, the following three step angle metrics were significantly smaller in those with PD: mean step angle (F1,48=69.75, P<.001, partial eta-square=0.59), initial step angle (F1,48=15.56, P<.001, partial eta-square=0.25), and last step angle (F1,48=61.99, P<.001, partial eta-square=0.56). Within the PD cohort, both the ALCT and DBS induced greater mean step angles (ACLT: F1,38=5.77, P=.02, partial eta-square=0.13; DBS: F1,52=8.53, P=.005, partial eta-square=0.14) and last step angles (ACLT: F1,38=10, P=.003, partial eta-square=0.21; DBS: F1,52=4.96, P=.003, partial eta-square=0.09), but no significant changes were observed in step time and number after the treatments. Additionally, these step angles were correlated with the Unified Parkinson's Disease Rating Scale, Part III score: mean step angle (single task: r=–0.60, P<.001; dual task: r=–0.52, P<.001), initial step angle (single task: r=–0.35, P=.006; dual task: r=–0.35, P=.01), and last step angle (single task: r=–0.43, P=.001; dual task: r=–0.41, P=.002). Conclusions This pilot study demonstrated that the gait angular characteristics, as quantified by the step angles, were sensitive to the disease severity of PD and, more importantly, can capture the effects of treatments on the gait, while the traditional metrics cannot. This indicates that these metrics may serve as novel markers to help the assessment of gait in those with PD as well as the rehabilitation of this vulnerable cohort.

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