‘Recoupling’ the attentional and motor control of preparatory postural adjustments to overcome Freezing of Gait in Parkinson’s

Abstract Objectives: This study examined if people with Parkinson’s and freezing of gait pathology (FoG) could be trained to increase preparatory weight-shift amplitude, and facilitate step initiation during FoG. Methods: Thirty-five people with Parkinson’s and FoG attempted to initiate forward walking from a stationary position caused by a freeze (n=17, FoG-F) or voluntarily stop (n=18, FoG-NF) in a Baseline condition and two conditions where an increased weight-shift amplitude was trained via: i) explicit verbal instruction, and ii) implicit movement analogies. Results: At Baseline, weight-shift amplitudes were smaller during: i) unsuccessful, compared to successful step initiations (FoG-F group), and ii) successful step initiations in the FoG-F group compared to FoG-NF. Both Verbal and Analogy training resulted in significant increases in weight-shift amplitude in both groups, and a corresponding pronounced reduction in unsuccessful attempts to initiate stepping (FoG-F group). Conclusions: Hypometric preparatory weight-shifting is associated with failure to initiate forward stepping in people with Parkinson’s and FoG. However, impaired weight-shift characteristics are modifiable through conscious strategies. This current study provides a novel and critical evaluation of preparatory weight-shift amplitudes during FoG events. The intervention described represents an attractive ‘rescue’ strategy and should be further scrutinised regarding limitations posed by physical and cognitive deficits.

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‘Recoupling’ the attentional and motor control of preparatory postural adjustments to overcome Freezing of Gait in Parkinson’s

10.21203/rs.3.rs-29124/v1 ◽

2020 ◽

Author(s):

Amy Maslivec ◽

Anna Fielding ◽

Mark Wilson ◽

Meriel Norris ◽

William Young

Keyword(s):

Motor Control ◽

Cognitive Deficits ◽

Critical Evaluation ◽

Freezing Of Gait ◽

Baseline Condition ◽

Verbal Instruction ◽

Step Initiation ◽

Weight Shift ◽

Pronounced Reduction ◽

Weight Shifting

Abstract Objectives This study examined if people with Parkinson’s and freezing of gait pathology (FoG) could be trained to increase preparatory weight-shift amplitude, and facilitate step initiation during FoG. Methods Thirty-five people with Parkinson’s and FoG attempted to initiate forward stepping either during a FoG event (n = 17, FoG-F) or following a voluntary stop (n = 18, FoG-NF) in a Baseline condition and two conditions where an increased weight-shift amplitude was trained via: i) Explicit verbal instruction, and ii) Implicit movement analogies. Results At Baseline, weight-shift amplitudes were smaller during: i) unsuccessful, compared to successful step initiations (FoG-F group), and ii) successful step initiations in the FoG-F group compared to FoG-NF. Both Verbal and Analogy training resulted in significant increases in weight-shift amplitude in both groups, and a corresponding pronounced reduction in unsuccessful attempts to initiate stepping (FoG-F group). Conclusions Hypometric preparatory weight-shifting is associated with failure to initiate forward stepping in people with Parkinson’s and FoG. However, impaired weight-shift characteristics are modifiable through conscious strategies. This current study provides a novel and critical evaluation of preparatory weight-shift amplitudes during FoG events. The intervention described represents an attractive ‘rescue’ strategy and should be further scrutinised regarding limitations posed by physical and cognitive deficits.

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‘Recoupling’ the attentional and motor control of preparatory postural adjustments to overcome freezing of gait in Parkinson’s

Journal of NeuroEngineering and Rehabilitation ◽

10.1186/s12984-020-00776-1 ◽

2020 ◽

Vol 17 (1) ◽

Author(s):

Amy Maslivec ◽

Anna Fielding ◽

Mark Wilson ◽

Meriel Norris ◽

William Young

Keyword(s):

Motor Control ◽

Cognitive Deficits ◽

Critical Evaluation ◽

Freezing Of Gait ◽

Baseline Condition ◽

Verbal Instruction ◽

Step Initiation ◽

Weight Shift ◽

Pronounced Reduction ◽

Weight Shifting

Abstract Objectives This study examined if people with Parkinson’s and freezing of gait pathology (FoG) could be trained to increase preparatory weight-shift amplitude, and facilitate step initiation during FoG. Methods Thirty-five people with Parkinson’s and FoG attempted to initiate forward walking from a stationary position caused by a freeze (n = 17, FoG-F) or voluntarily stop (n = 18, FoG-NF) in a Baseline condition and two conditions where an increased weight-shift amplitude was trained via: (i) explicit verbal instruction, and (ii) implicit movement analogies. Results At Baseline, weight-shift amplitudes were smaller during: (i) unsuccessful, compared to successful step initiations (FoG-F group), and (ii) successful step initiations in the FoG-F group compared to FoG-NF. Both Verbal and Analogy training resulted in significant increases in weight-shift amplitude in both groups, and a corresponding pronounced reduction in unsuccessful attempts to initiate stepping (FoG-F group). Conclusions Hypometric preparatory weight-shifting is associated with failure to initiate forward stepping in people with Parkinson’s and FoG. However, impaired weight-shift characteristics are modifiable through conscious strategies. This current study provides a novel and critical evaluation of preparatory weight-shift amplitudes during FoG events. The intervention described represents an attractive ‘rescue’ strategy and should be further scrutinised regarding limitations posed by physical and cognitive deficits.

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‘Recoupling’ the attentional and motor control of preparatory postural adjustments to overcome Freezing of Gait in Parkinson’s

10.21203/rs.3.rs-29124/v2 ◽

2020 ◽

Author(s):

Amy Maslivec ◽

Anna Fielding ◽

Mark Wilson ◽

Meriel Norris ◽

William Young

Keyword(s):

Motor Control ◽

Cognitive Deficits ◽

Critical Evaluation ◽

Freezing Of Gait ◽

Verbal Instruction ◽

Step Initiation ◽

Weight Shift ◽

Baseline Weight ◽

Pronounced Reduction ◽

Weight Shifting

Abstract Objectives This study examined if people with Parkinson’s and freezing of gait pathology (FoG) could be trained to increase preparatory weight-shift amplitude, and facilitate step initiation during FoG. Methods Thirty-five people with Parkinson’s and FoG attempted to initiate forward stepping either during a FoG event (n=17, FoG-F) or following a voluntary stop (n=18, FoG-NF) in a Baseline condition and two conditions where an increased weight-shift amplitude was trained via: i) Explicit verbal instruction, and ii) Implicit movement analogies. Results At Baseline , weight-shift amplitudes were smaller during: i) unsuccessful, compared to successful step initiations (FoG-F group), and ii) successful step initiations in the FoG-F group compared to FoG-NF. Both Verbal and Analogy training resulted in significant increases in weight-shift amplitude in both groups, and a corresponding pronounced reduction in unsuccessful attempts to initiate stepping (FoG-F group). Conclusions Hypometric preparatory weight-shifting is associated with failure to initiate forward stepping in people with Parkinson’s and FoG. However, impaired weight-shift characteristics are modifiable through conscious strategies. This current study provides a novel and critical evaluation of preparatory weight-shift amplitudes during FoG events. The intervention described represents an attractive ‘rescue’ strategy and should be further scrutinised regarding limitations posed by physical and cognitive deficits.

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Which Aspects of Postural Control Differentiate between Patients with Parkinson’s Disease with and without Freezing of Gait?

Parkinson s Disease ◽

10.1155/2013/971480 ◽

2013 ◽

Vol 2013 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Griet Vervoort ◽

Evelien Nackaerts ◽

Farshid Mohammadi ◽

Elke Heremans ◽

Sabine Verschueren ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Postural Control ◽

Freezing Of Gait ◽

Sensory Information ◽

Response Strength ◽

Dynamic Posturography ◽

Directional Control ◽

Weight Shift ◽

Weight Shifting

This exploratory study aimed to identify which aspects of postural control are able to distinguish between subgroups of patients with Parkinson’s disease (PD) and controls. Balance was tested using static and dynamic posturography. Freezers (n=9), nonfreezers (n=10), and controls (n=10) stood on a movable force platform and performed 3 randomly assigned tests: (1) sensory organization test (SOT) to evaluate the effective use of sensory information, (2) motor control test (MCT) to assess automatic postural reactions in response to platform perturbations, and (3) rhythmic weight shift test (RWS) to evaluate the ability to voluntarily move the center of gravity (COG) mediolaterally and anterior-posteriorly (AP). The respective outcome measures were equilibrium and postural strategy scores, response strength and amplitude of weight shift. Patients were in the “on” phase of the medication cycle. In general, freezers performed similarly on SOT and MCT compared to nonfreezers. Freezers showed an intact postural strategy during sensory manipulations and an appropriate response to external perturbations. However, during voluntary weight shifting, freezers showed poorer directional control compared to nonfreezers and controls. This suggests that freezers have adequate automatic postural control and sensory integration abilities in quiet stance, but show specific directional control deficits when weight shifting is voluntary.

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Impaired Weight-Shift Amplitude in People with Parkinson’s Disease with Freezing of Gait

Journal of Parkinson s Disease ◽

10.3233/jpd-202370 ◽

2021 ◽

pp. 1-14

Author(s):

Bauke Wybren Dijkstra ◽

Moran Gilat ◽

L. Eduardo Cofré Lizama ◽

Martina Mancini ◽

Bruno Bergmans ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Balance Control ◽

Dynamic Balance ◽

Center Of Mass ◽

Freezing Of Gait ◽

Dopaminergic Medication ◽

Weight Shift ◽

Future Work ◽

Weight Shifting

Background: People with Parkinson’s disease and freezing of gait (FOG; freezers) suffer from pronounced postural instability. However, the relationship between these phenomena remains unclear and has mostly been tested in paradigms requiring step generation. Objective: To determine if freezing-related dynamic balance deficits are present during a task without stepping and determine the influence of dopaminergic medication on dynamic balance control. Methods: Twenty-two freezers, 16 non-freezers, and 20 healthy age-matched controls performed mediolateral weight-shifts at increasing frequencies when following a visual target projected on a screen (MELBA task). The amplitude and phase shift differences between center of mass and target motion were measured. Balance scores (Mini-BESTest), 360° turning speed and the freezing ratio were also measured. Subjects with Parkinson’s disease were tested ON and partial OFF (overnight withdrawal) dopaminergic medication. Results: Freezers had comparable turning speed and balance scores to non-freezers and took more levodopa. Freezers produced hypokinetic weight-shift amplitudes throughout the MELBA task compared to non-freezers (p = 0.002), which were already present at task onset (p < 0.001). Freezers also displayed an earlier weight-shift breakdown than controls when OFF-medication (p = 0.008). Medication improved mediolateral weight-shifting in freezers and non-freezers. Freezers decreased their freezing ratio in response to medication. Conclusion: Hypokinetic weight-shifting proved a marked postural control deficit in freezers, while balance scores and turning speed were similar to non-freezers. Both weight-shift amplitudes and the freezing ratio were responsive to medication in freezers, suggesting axial motor vigor is levodopa-responsive. Future work needs to test whether weight-shifting and freezing severity can be further ameliorated through training.

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Anticipatory weight shift between arms when reaching from a crouched posture

Journal of Neurophysiology ◽

10.1152/jn.00644.2020 ◽

2021 ◽

Author(s):

Rosemary Gallagher ◽

Stephaine Perez ◽

Derek DeLuca ◽

Isaac L. Kurtzer

Keyword(s):

Body Weight ◽

Muscle Activity ◽

Force Plate ◽

Vertical Axis ◽

The Body ◽

Reaching Movements ◽

Reactive Control ◽

Step Initiation ◽

Weight Shift ◽

The Many

Reaching movements performed from a crouched body posture require a shift of body weight from both arms to one arm. This situation has remained unexamined despite the analogous load requirements during step initiation and the many studies of reaching from a seated or standing posture. To determine whether the body weight shift involves anticipatory or exclusively reactive control we obtained force plate records, hand kinematics, and arm muscle activity from 11 healthy right-handed participants. They performed reaching movements with their left and right arm in two speed contexts - 'comfortable' and 'as fast as possible' - and two postural contexts - a less stable knees-together posture and more stable knees-apart posture. Weight-shifts involved anticipatory postural actions (APA) by the reaching and stance arms that were opposing in the vertical axis and aligned in the side-to-side axis similar to APAs by the legs for step initiation. Weight-shift APAs were correlated in time and magnitude, present in both speed contexts, more vigorous with the knees placed together, and similar when reaching with the dominant or non-dominant arm. The initial weight-shift was preceded by bursts of muscle activity in the shoulder and elbow extensors (posterior deltoid and triceps lateral) of the reach arm and shoulder flexor (pectoralis major) of the stance arm which indicates their causal role; leg muscles may have indirectly contributed but were not recorded. The strong functional similarity of weight-shift APAs during crouched reaching to human stepping and cats reaching suggests that they are a core feature of posture-movement coordination.

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The significance of the loss of presynaptic inhibition for step initiation in parkinsonian individuals with freezing of gait

The Journal of Physiology ◽

10.1113/jp282365 ◽

2021 ◽

Author(s):

Halil Onder ◽

Bilge Kocer ◽

Selcuk Comoglu

Keyword(s):

Presynaptic Inhibition ◽

Freezing Of Gait ◽

Step Initiation

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The Therapeutic Effect of Nordic Walking on Freezing of Gait in Parkinson’s Disease: A Pilot Study

Parkinson s Disease ◽

10.1155/2019/3846279 ◽

2019 ◽

Vol 2019 ◽

pp. 1-10

Author(s):

Agata Wróblewska ◽

Agata Gajos ◽

Urszula Smyczyńska ◽

Andrzej Bogucki

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Research Question ◽

Freezing Of Gait ◽

Intervention Group ◽

Future Research ◽

Control Group ◽

Nordic Walking ◽

Provocative Test ◽

Step Initiation

Introduction. The effectiveness of the currently utilized therapies for FoG is limited. Several studies demonstrated a beneficial impact of Nordic walking (NW) on several gait parameters in Parkinson’s disease, but only one paper reported reduction of freezing. Research Question. In the present study, the question is whether NW is an effective therapeutic intervention in FoG. Methods. Twenty PD subjects trained NW for 12 weeks, with a frequency of twice per week. Each session lasted about 60 minutes. Twenty patients in the control group did not use any form of physiotherapy (no-intervention group). Freezing of Gait Questionnaire (FOGQ), the Timed Up and Go (TUG) test, and the Provocative Test for Freezing and Motor Blocks (PTFMB) were performed at baseline, immediately after the end of NW program, and three months later. Results. The results of FOGQ, TUG, and total PTFMB revealed significant improvement after completing the exercise program, and this effect persisted at follow-up. The results of the PTFMB subtests showed a different effect of NW on particular subtypes of FoG. Start hesitation, sudden transient blocks that interrupt gait, and blocks on turning improved considerably, while motor blocks, when walking through narrow space and on reaching the target, did not respond to NW training. Significance. The results show, for the first time, that FoG during turning and step initiation, two most common forms of this gait disorder, has been significantly reduced by NW training. Different responses of particular subtypes of FoG to NW probably reflect their different pathophysiologies. Conclusions. The present study showed that NW training had a beneficial effect on FOG in PD and that the achieved improvement is long-lasting. Future research should clarify whether the observed improvement limited to FoG triggered by only some circumstances reflects different pathomechanisms of FoG subtypes.

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