Differential Gait Decline in Parkinson’s Disease Enhances Discrimination of Gait Freezers from Non-Freezers

2020 ◽  
Vol 10 (4) ◽  
pp. 1657-1673
Author(s):  
Aliyah Glover ◽  
Lakshmi Pillai ◽  
Shannon Doerhoff ◽  
Tuhin Virmani
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Regression Model ◽  
Stride Length ◽  
Freezing Of Gait ◽  
Binary Regression ◽  
Levodopa Dose ◽  
Gait Parameters ◽  
Neuroprotective Strategies ◽  
Change In Mean

Background: Freezing of gait (FOG) is a debilitating feature of Parkinson’s disease (PD) for which treatments are limited. To develop neuroprotective strategies, determining whether disease progression is different in phenotypic variants of PD is essential. Objective: To determine if freezers have a faster decline in spatiotemporal gait parameters. Methods: Subjects were enrolled in a longitudinal study and assessed every 3– 6 months. Continuous gait in the levodopa ON-state was collected using a gait mat (Protokinetics). The slope of change/year in spatiotemporal gait parameters was calculated. Results: 26 freezers, 31 non-freezers, and 25 controls completed an average of 6 visits over 28 months. Freezers had a faster decline in mean stride-length, stride-velocity, swing-%, single-support-%, and variability in single-support-% compared to non-freezers (p < 0.05). Gait decline was not correlated with initial levodopa dose, duration of levodopa therapy, change in levodopa dose or change in Montreal Cognitive Assessment scores (p > 0.25). Gait progression parameters were required to obtain 95% accuracy in categorizing freezers and non-freezers groups in a forward step-wise binary regression model. Change in mean stride-length, mean stride-width, and swing-% variability along with initial foot-length variability, mean swing-% and apathy scores were significant variables in the model. Conclusion: Freezers had a faster temporal decline in objectively quantified gait, and inclusion of longitudinal gait changes in a binary regression model greatly increased categorization accuracy. Levodopa dosing, cognitive decline and disease severity were not significant in our model. Early detection of this differential decline may help define freezing prone groups for testing putative treatments.

scholarly journals Quantitative assessment of gait parameters in people with Parkinson's disease in laboratory and clinical setting: Are the measures interchangeable?

2018 ◽  
Vol 10 (2) ◽  
Author(s):  
Massimiliano Pau ◽  
Federica Corona ◽  
Roberta Pili ◽  
Carlo Casula ◽  
Marco Guicciardi ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Clinical Setting ◽  
Stride Length ◽  
Experimental Setting ◽  
Optoelectronic System ◽  
Double Support ◽  
Gait Parameters ◽  
Spatio Temporal ◽  
Wearable Accelerometers

This study aimed to investigate possible differences in spatio-temporal gait parameters of people with Parkinson’s Disease (pwPD) when they are tested either in laboratory using 3D Gait Analysis or in a clinical setting using wearable accelerometers. The main spatio-temporal gait parameters (speed, cadence, stride length, stance, swing and double support duration) of 31 pwPD were acquired: i) using a wearable accelerometer in a clinical setting while wearing shoes (ISS); ii) same as condition 1, but barefoot (ISB); iii) using an optoelectronic system (OES) undressed and barefoot. While no significant differences were found for cadence, stance, swing and double support duration, the experimental setting affected speed and stride length that decreased (by 17% and 12% respectively, P<0.005) when passing from the clinical (ISS) to the laboratory (OES) setting. These results suggest that gait assessment should be always performed in the same conditions to avoid errors, which may lead to inaccurate patient’s evaluations.

scholarly journals Association of Gait Characteristics and Depression in Patients with Parkinson’s Disease Assessed in Goal-Directed Locomotion Task

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Péter Kincses ◽  
Norbert Kovács ◽  
Kázmér Karádi ◽  
Ádám Feldmann ◽  
Krisztina Dorn ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Stride Length ◽  
Gait Pattern ◽  
Exact Nature ◽  
Gait Characteristics ◽  
Gait Parameters ◽  
Healthy Control ◽  
Affective Variables ◽  
Affective Disturbances

Introduction.In the genesis of Parkinson’s disease (PD) clinical phenomenology the exact nature of the association between bradykinesia and affective variables is unclear. In the present study, we analyzed the gait characteristics and level of depression in PD and healthy volunteers.Methods.Patients with PD (n=48) and healthy controls (n=52) were recruited for the present study. Walking speed, stride length, and cadence were compared between groups while participants completed a goal-directed locomotion task under visually controlled (VC) and visually noncontrolled conditions (VnC).Results.Significantly higher depression scores were found in PD comparing to healthy control groups. In PD, depression was associated with gait components in the VC wherein the place of the target was visible. In contrast, in healthy subjects the depression was associated with gait components in VnC wherein the location and image of the target were memorized and recalled. In patients with PD and depression, the visually deprived multitask augments the rate of cadence and diminishes stride length, while velocity remains relatively unchanged. The depression associated with gait characteristics as a comorbid affective factor in PD, and that impairs the coherence of gait pattern.Conclusion.The relationship between depression and gait parameters appears to indicate that PD not only is a neurological disease but also incorporates affective disturbances that associate with the regulation of gait characteristics.

scholarly journals Clinical Relevance of Standardized Mobile Gait Tests. Reliability Analysis Between Gait Recordings at Hospital and Home in Parkinson’s Disease: A Pilot Study

2020 ◽  
Vol 10 (4) ◽  
pp. 1763-1773
Author(s):  
Heiko Gaßner ◽  
Philipp Sanders ◽  
Alisa Dietrich ◽  
Franz Marxreiter ◽  
Bjoern M. Eskofier ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Pilot Study ◽  
Reliability Analysis ◽  
Clinical Relevance ◽  
Stride Length ◽  
Standardized Test ◽  
Gait Velocity ◽  
Gait Parameters ◽  
At Home

Background: Gait impairments in Parkinson’s disease (PD) are quantified using inertial sensors under standardized test settings in the hospital. Recent studies focused on the assessment of free-living gait in PD. However, the clinical relevance of standardized gait tests recorded at the patient’s home is unclear. Objective: To evaluate the reliability of supervised, standardized sensor-based gait outcomes at home compared to the hospital. Methods: Patients with PD (n = 20) were rated by a trained investigator using the Unified Parkinson Disease Rating Scale (UPDRS-III). Gait tests included a standardized 4×10 m walk test and the Timed Up and Go Test (TUG). Tests were performed in the hospital (HOSPITAL) and at patients’ home (HOME), and controlled for investigator, time of the day, and medication. Statistics included reliability analysis using Intra-Class correlations and Bland-Altman plots. Results: UPDRS-III and TUG were comparable between HOSPITAL and HOME. PD patients’ gait at HOME was slower (gait velocity Δ= –0.07±0.11 m/s, –6.1%), strides were shorter (stride length Δ= –9.2±9.4 cm; –7.3%), and shuffling of gait was more present (maximum toe-clearance Δ= –0.7±2.5 cm; –8.8%). Particularly, narrow walkways (<85 cm) resulted in a significant reduction of gait velocity at home. Reliability analysis (HOSPITAL vs. HOME) revealed excellent ICC coefficients for UPDRS-III (0.950, p < 0.000) and gait parameters (e.g., stride length: 0.898, p < 0.000; gait velocity: 0.914, p < 0.000; stance time: 0.922, p < 0.000; stride time: 0.907, p < 0.000). Conclusion: This pilot study underlined the clinical relevance of gait parameters by showing excellent reliability for supervised, standardized gait tests at HOSPITAL and HOME, even though gait parameters were different between test conditions.

Periventricular White Matter Lesions Influence Gait Functions in Parkinson’s Disease

2019 ◽  
Vol 81 (3-4) ◽  
pp. 120-127 ◽  
Author(s):  
Kunio Toda ◽  
Mutsumi Iijima ◽  
Kazuo Kitagawa
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
White Matter ◽  
Frontal Lobe ◽  
Stride Length ◽  
Walking Speed ◽  
White Matter Lesions ◽  
Periventricular White Matter ◽  
Gait Parameters ◽  
Calculation Task

Objective: We quantitatively evaluated the gait of Parkinson’s disease (PD) patients over a 10-m course during normal walking and during dual-task walking while performing a calculation task, and clarified which parts of white matter lesions (WML) influence gait in PD patients. Methods: Gait parameters, including walking speed, gait cycle, stride length, and left-right instability, were measured in 64 PD patients and 20 controls who walked 10 m with normal gait and as they were performing a calculation task. WML on magnetic resonance imaging (MRI) of PD patients were scored according to Scheltens’ criteria, and associations with gait parameters were investigated. Results: Compared to controls, the PD group showed decreased walking speed and narrowed stride (p < 0.05), and the stride length and step time coefficient of variation changed significantly during the calculation task (p < 0.001). Frontal lobe functions correlated positively with walking speed and stride during the calculation task in patients with PD (p < 0.05). The total score for periventricular hyperintensity (PVH) on MRI correlated with walking speed and stride (p < 0.01). Multiple regression analysis revealed significant correlations between walking speed and frontal cap of PVH, and between stride and occipital cap (p < 0.05). Conclusion: Gait of PD patients deteriorated not only due to motor dysfunction but also due to mental burden in association with frontal lobe function and periventricular lesions of cerebral white matter.

scholarly journals Freezing of gait and postural instability: the unpredictable response to levodopa in Parkinson’s disease

2019 ◽  
Vol 12 (7) ◽  
pp. e229224 ◽  
Author(s):  
Fradique Moreira ◽  
Inês Rebelo Gomes ◽  
Cristina Januário
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Freezing Of Gait ◽  
Postural Instability ◽  
Motor Symptoms ◽  
Levodopa Dose ◽  
Paradoxical Response ◽  
Axial Symptoms ◽  
Video Documentation ◽  
Dose Dependent

Freezing of gait (FOG) and postural instability are challenging motor symptoms that present a serious therapeutic dilemma in Parkinson’s disease. Appropriate distinction between FOG subtypes may be difficult during routine clinical visits, as shown in the case we present. The patient was examined in three different states in relation to levodopa (L-DOPA) and apomorphine subcutaneous (sc) tests with video documentation: (1) ‘overnight-off’, after 12 hours without medication; (2)‘on’, 60 min after intake of regular levodopa dose (200 mg) and 20 min after 2 mg of apomorphine sc; and (3) ‘supra-on’, after 350 mg of L-DOPA and 3 mg of apomorphine sc. The patient clearly showed a dose-dependent paradoxical response to L-DOPA treatment with the emergence of severe FOG and postural instability. The tendency to develop these axial symptoms was less pronounced with apomorphine at doses that achieved similar improvements of other Parkinsonian features.

Corelation of gait parameters, cognitive impairment and brain atrophy in patients with Parkinson’s disease and the «normally aging population»

2021 ◽  
Author(s):  
P. Y. Diachenko ◽  
I. I. Leta ◽  
G. S. Moskovko
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Function ◽  
Brain Atrophy ◽  
Stride Length ◽  
Aging Population ◽  
Step Length ◽  
Normal Aging ◽  
Gait Velocity ◽  
Gait Parameters

Objective — to identify the most significant markers of gait that indicate a decrease in cognitive function based on investigation of the corelation of cognitive impairment, gait parameters and atrophy of brain structures in groups of patients with Parkinson’s disease and the «normally aging population». Methods and subjects. 66 subjects were examined: 30 patients with Parkinson’s disease (mean age 54.9 ± 5.9, 50 % men) and 33 without neurological pathology (mean age 52.7 ± 7.6, 66 % men). All of them underwent neurological examination, assessment of temporal and spatial gait parameters using the GaitRite system, grading of brain atrophy using a comprehensive visual rating scale of MRI scans and assessment of cognitive status using the Montreal Cognitive Assessment Scale. Results. Cognitive performance was significantly lower in the subgroup of patients with Parkinson’s disease compared to the subgroup of «normally aging population». The gait profile of patients with Parkinson’s disease significantly differed from the gait profile of individuals from the «normal aging» subgroup by slower gait velocity, shorter step length and stride length for both limbs. The gait parameters, which showed a strong correlation with cognitive tests, differed in the subgroups, but gait velocity, stride length and step length for both extremities were common among them. These common gait parameters showed a strong direct correlation with brain atrophy in the subgroup of patients with Parkinson’s disease, but only velocity correlated with atrophy in the subgroup of «normal aging» among all of them. It was determined by the method of multiple regression analysis that it was precisely the atrophy of the brain that turned out to be the most influential factor in the decrease in cognitive function in the general group and subgroups. Conclusions. The gait profile in Parkinson’s disease subgroup is characterized by lower velocity, shorter step length, stride length for both limbs and significantly differs from the subgroup of «normal aging». These changes are a consequence of the influence of the disease on the motor sphere. Velocity showed a strong correlation in both subgroups not only with cognitive abilities, but also with cerebral atrophy. This confirms the hypothesis about the possibility of using gait velocity as a universal sensitive marker for current and longitudinal assessment of cognitive function, especially in clinical practice.  

scholarly journals Gait parameters of Parkinson’s disease compared with healthy controls: a systematic review and meta-analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ana Paula Janner Zanardi ◽  
Edson Soares da Silva ◽  
Rochelle Rocha Costa ◽  
Elren Passos-Monteiro ◽  
Ivan Oliveira dos Santos ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Stride Length ◽  
Walking Speed ◽  
Meta Analysis ◽  
The Self ◽  
Double Support ◽  
Swing Time ◽  
Gait Parameters ◽  
Healthy Control

AbstractWe systematically reviewed observational and clinical trials (baseline) studies examining differences in gait parameters between Parkinson’s disease (PD) in on-medication state and healthy control. Four electronic databases were searched (November-2018 and updated in October-2020). Independent researchers identified studies that evaluated gait parameters measured quantitatively during self-selected walking speed. Risk of bias was assessed using an instrument proposed by Downs and Black (1998). Pooled effects were reported as standardized mean differences and 95% confidence intervals using a random-effects model. A total of 72 studies involving 3027 participants (1510 with PD and 1517 health control) met the inclusion criteria. The self-selected walking speed, stride length, swing time and hip excursion were reduced in people with PD compared with healthy control. Additionally, PD subjects presented higher cadence and double support time. Although with a smaller difference for treadmill, walking speed is reduced both on treadmill (.13 m s−1) and on overground (.17 m s−1) in PD. The self-select walking speed, stride length, cadence, double support, swing time and sagittal hip angle were altered in people with PD compared with healthy control. The precise determination of these modifications will be beneficial in determining which intervention elements are most critical in bringing about positive, clinically meaningful changes in individuals with PD (PROSPERO protocol CRD42018113042).

scholarly journals Beneficial Effect of Foot Plantar Stimulation in Gait Parameters in Individuals with Parkinson’s Disease

2020 ◽  
Vol 10 (2) ◽  
pp. 69 ◽  
Author(s):  
Lorenzo Brognara ◽  
Emmanuel Navarro-Flores ◽  
Lorenzo Iachemet ◽  
Nuria Serra-Catalá ◽  
Omar Cauli
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
3D Printing ◽  
Neurological Disorders ◽  
Stride Length ◽  
Control Group ◽  
Gait Impairment ◽  
Gait Parameters ◽  
Plantar Stimulation ◽  
Positive Effect

New treatments based on peripheral stimulation of the sensory-motor system have shown to be promising in rehabilitation strategies for patients with neurological disorders, including Parkinson’s disease (PD), especially in regards to reducing gait impairment, and hence, the incidence of falls. The aim of this study was to evaluate the change in several gait parameters measured by sensor inertial measurement in PD patients after acute plantar stimulation, under the distal phalanx of the big toe, and underneath the head of the first metatarsal joint of both feet, using a 3D printing insole. In order to assess whether the effects are selective for PD patients, we compared the effect of the treatment in a control group (age-matched) consisting of patients with other neurological disorders which also displayed gait and balance impairment, and a similar cognitive function, depressive symptoms, body mass index, and comorbidity burden observed in the PD group. Plantar foot stimulation in PD patients eliminated the significant (p < 0.05) alterations existing in stride asymmetry and in stride variability. When comparing the effects of post-plantar stimulation with the respective basal level, considered as 100% in both groups, we observed a significant (p = 0.019, Mann–Whitney test) increase in stride length compared to basal in the PD group and control group. No significant effects of foot plantar stimulation were observed in any of the gait parameters in the control group. Plantar foot stimulation has a positive effect on the step and stride length, and has a positive effect on walking stability, measured by the increase in stride length. No significant effect was observed on bradykinesia because it did not improve walking velocity. These findings indicate that foot plantar stimulation using a 3D printing insole seems to generate a more stable walking pattern in PD patients, with an interesting applicability, and a low-cost, for reducing gait impairment in PD patients.

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