Dual-Task Costs of Quantitative Gait Parameters While Walking and Turning in People with Parkinson’s Disease: Beyond Gait Speed

2020 ◽  
pp. 1-12
Author(s):  
Rodrigo Vitorio ◽  
Naoya Hasegawa ◽  
Patricia Carlson-Kuhta ◽  
John G. Nutt ◽  
Fay B. Horak ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Range Of Motion ◽  
Disease Severity ◽  
Outcome Measures ◽  
Dual Task ◽  
Gait Speed ◽  
Disease Duration ◽  
Healthy Individuals ◽  
Foot Strike ◽  
Strike Angle

Background: There is a lack of recommendations for selecting the most appropriate gait measures of Parkinson’s disease (PD)-specific dual-task costs to use in clinical practice and research. Objective: We aimed to identify measures of dual-task costs of gait and turning that best discriminate performance in people with PD from healthy individuals. We also investigated the relationship between the most discriminative measures of dual-task costs of gait and turning with disease severity and disease duration. Methods: People with mild-to-moderate PD (n = 144) and age-matched healthy individuals (n = 79) wore 8 inertial sensors while walking under single and dual-task (reciting every other letter of the alphabet) conditions. Outcome measures included 26 objective measures within four gait domains (upper/lower body, turning and variability). The area under the curve (AUC) from the receiver-operator characteristic plot was calculated to compare discriminative ability of dual-task costs on gait across outcome measures. Results: PD-specific, dual-task interference was identified for arm range of motion, foot strike angle, turn velocity and turn duration. Arm range of motion (AUC = 0.73) and foot strike angle (AUC = 0.68) had the largest AUCs across dual-task costs measures and they were associated with disease severity and/or disease duration. In contrast, the most commonly used dual-task gait measure, gait speed, showed an AUC of only 0.54. Conclusion: Findings suggest that people with PD rely more than healthy individuals on executive-attentional resources to control arm swing, foot strike, and turning, but not gait speed. The dual-task costs of arm range of motion best discriminated people with PD from healthy individuals.

scholarly journals Effects of the agility boot camp with cognitive challenge (ABC-C) exercise program for Parkinson’s disease

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Se Hee Jung ◽  
Naoya Hasegawa ◽  
Martina Mancini ◽  
Laurie A. King ◽  
Patricia Carlson-Kuhta ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Dual Task ◽  
Gait Speed ◽  
Treatment Effects ◽  
Exercise Intervention ◽  
Boot Camp ◽  
Dual Task Cost ◽  
Cognitive Challenge ◽  
Updrs Part

Abstract Few exercise interventions practice both gait and balance tasks with cognitive tasks to improve functional mobility in people with PD. We aimed to investigate whether the Agility Boot Camp with Cognitive Challenge (ABC-C), that simultaneously targets both mobility and cognitive function, improves dynamic balance and dual-task gait in individuals with Parkinson’s disease (PD). We used a cross-over, single-blind, randomized controlled trial to determine efficacy of the exercise intervention. Eighty-six people with idiopathic PD were randomized into either an exercise (ABC-C)-first or an active, placebo, education-first intervention and then crossed over to the other intervention. Both interventions were carried out in small groups led by a certified exercise trainer (90-min sessions, 3 times a week, for 6 weeks). Outcome measures were assessed Off levodopa at baseline and after the first and second interventions. A linear mixed-effects model tested the treatment effects on the Mini-BESTest for balance, dual-task cost on gait speed, SCOPA-COG, the UPDRS Parts II and III and the PDQ-39. Although no significant treatment effects were observed for the Mini-BESTest, SCOPA-COG or MDS-UPDRS Part III, the ABC-C intervention significantly improved the following outcomes: anticipatory postural adjustment sub-score of the Mini-BESTest (p = 0.004), dual-task cost on gait speed (p = 0.001), MDS-UPDRS Part II score (p = 0.01), PIGD sub-score of MDS-UPDRS Part III (p = 0.02), and the activities of daily living domain of the PDQ-39 (p = 0.003). Participants with more severe motor impairment or more severe cognitive dysfunction improved their total Mini-BESTest scores after exercise. The ABC-C exercise intervention can improve specific balance deficits, cognitive-gait interference, and perceived functional independence and quality of life, especially in participants with more severe PD, but a longer period of intervention may be required to improve global cognitive and motor function.

scholarly journals The Effects of Heel Lifts on Dynamic Measures of Gait and Static Posture in Individuals with Parkinson’s disease

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Sarah Uno ◽  
Elizabeth Jusko ◽  
Breanna Roderos ◽  
Jennifer D. Hastings
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Range Of Motion ◽  
Outcome Measures ◽  
Tilt Angle ◽  
Head Tilt ◽  
Balance Confidence ◽  
Postural Alignment ◽  
Abc Scale ◽  
Heel Lift

This study expands upon the Hastings et al (2018) study on the use of heel lifts to change static postural alignment in persons with Parkinson's Disease (PD) and further explores whether the use of heel lifts provide improvements in dynamic gait parameters, Timed Up and Go (TUG) scores, and balance confidence. Outcome measures were taken with and without the heel lifts in place, at two data collection dates. Photographs were analyzed for postural alignment measures using ImageJ software and video was analyzed for gait and turning parameters utilizing the Dite and Temple scale. The Activities-specific Balance Confidence (ABC) scale was collected at baseline and after two weeks of heel lift use, otherwise outcome measures were performed in the reverse order on the first and second session to account for ordering, practice, and fatigue effects. Statistical analysis included paired t-tests for outcome measures and Pearson product correlation between the degree of plantarflexion contracture and ABC scale and overall balance confidence and fall history. We found that head tilt angle and turn time significantly improved (p = .037) (p = .002) with use of heel lifts. Turn time correlated to overall balance confidence (r = -.802, p = .000) and overall balance confidence correlated to fall history (r = -.501, p = .041). This study showed that accommodating a lack of ankle dorsiflexion range of motion with heel lifts significantly improves head tilt angle and decreases turn time as compared to without heel lifts, but has no significant effect on step length, gait speed, or overall TUG score in individuals with PD. Because our work shows that limited range of motion at the ankle contributes to real and perceived balance difficulties healthcare providers working with any population of patients exhibiting balance problems should include this measurement in their assessment and consider intervention with a heel lift when limitations are found.

scholarly journals Motor–Cognitive Treadmill Training With Virtual Reality in Parkinson’s Disease: The Effect of Training Duration

2022 ◽  
Vol 13 ◽  
Author(s):  
Elisa Pelosin ◽  
Chiara Ponte ◽  
Martina Putzolu ◽  
Giovanna Lagravinese ◽  
Jeffrey M. Hausdorff ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Virtual Reality ◽  
Cognitive Performance ◽  
Dual Task ◽  
Cognitive Functions ◽  
Gait Speed ◽  
Fall Risk ◽  
Treadmill Training ◽  
Gait Performance

Treadmill training with virtual reality (TT + VR) has been shown to improve gait performance and to reduce fall risk in Parkinson’s disease (PD). However, there is no consensus on the optimal training duration. This study is a sub-study of the V-TIME randomized clinical trial (NCT01732653). In this study, we explored the effect of the duration of training based on the motor–cognitive interaction on motor and cognitive performance and on fall risk in subjects with PD. Patients in Hoehn and Yahr stages II–III, aged between 40 and 70 years, were included. In total, 96 patients with PD were assigned to 6 or 12 weeks of TT + VR intervention, and 77 patients completed the full protocol. Outcome measures for gait and cognitive performance were assessed at baseline, immediately after training, and at 1- and 6-month follow-up. The incident rate of falls in the 6-month pre-intervention was compared with that in the 6-month post-intervention. Dual-task gait performance (gait speed, gait speed variability and stride length under cognitive dual task and obstacle negotiation, and the leading foot clearance in obstacle negotiation) improved similarly in both groups with gains sustained at 6-month follow-up. A higher decrease in fall rate and fear of falling were observed in participants assigned to the 12-week intervention than the 6-week intervention. Improvements in cognitive functions (i.e., executive functions, visuospatial ability, and attention) were seen only in participants enrolled in 12-week training up to 1-month follow-up but vanished at the 6-month evaluation. Our results suggest that a longer TT + VR training leads to greater improvements in cognitive functions especially those directly addressed by the virtual environment.

scholarly journals Measuring implicit sequence learning and dual task ability in mild to moderate Parkinson´s disease: A feasibility study

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0251849
Author(s):  
Malin Freidle ◽  
Hanna Johansson ◽  
Alexander V. Lebedev ◽  
Urban Ekman ◽  
Martin Lövdén ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Reaction Time ◽  
Dual Task ◽  
Sequence Learning ◽  
Small Sample Size ◽  
Small Sample ◽  
Difficulty Level ◽  
Implicit Sequence Learning ◽  
Healthy Individuals

We investigated the feasibility aspects of two choice reaction time tasks designed to assess implicit sequence learning and dual task ability in individuals with mild to moderate Parkinson’s disease in comparison to healthy individuals. Twelve individuals with mild to moderate Parkinson’s disease and 12 healthy individuals, all ≥ 60 years of age, were included. A serial reaction time task was used as a measure of implicit sequence learning and a similar task but with the addition of a simple counting task, was used as a measure of dual task ability. We have present thorough descriptive statistics of the data but we have refrained from any inferential statistics due to the small sample size. All participants understood the task instructions and the difficulty level of both tasks was deemed acceptable. There were indications of task fatigue that demand careful choices for how best to analyse the data from such tasks in future trials. Ceiling effects were present in several accuracy outcomes, but not in the reaction time outcomes. Overall, we found both tasks to be feasible to use in samples of individuals with mild to moderate Parkinson’s disease and healthy older individuals.

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

2020 ◽  
Author(s):  
Douglas N Martini ◽  
Rosie Morris ◽  
Tara M Madhyastha ◽  
Thomas J Grabowski ◽  
John Oakley ◽  
...  
Keyword(s):  
Older Adults ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Dual Task ◽  
Stride Length ◽  
Inertial Sensors ◽  
Postural Sway ◽  
Single Task ◽  
Immediate Recall ◽  
Foot Strike

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.

scholarly journals Dual-task walking reduces lower limb range of motion in individuals with Parkinson’s disease and freezing of gait: But does it happen during what events through the gait cycle?

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243133
Author(s):  
Camila Pinto ◽  
Ana Paula Salazar ◽  
Ewald Max Hennig ◽  
Graham Kerr ◽  
Aline Souza Pagnussat
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Range Of Motion ◽  
Dual Task ◽  
Lower Limb ◽  
Gait Cycle ◽  
Freezing Of Gait ◽  
Heel Strike ◽  
Discrete Analysis ◽  
Flexion Extension

Background It is unclear how dual-task gait influences the lower limb range of motion (RoM) in people with Parkinson’s disease (PD) and freezing of gait (FOG). The lower limb kinematics during dual-task gait might differ from regular gait, but during what events in the gait cycle? Methods This is an observational within-subjects study. Thirty-two individuals with PD and FOG underwent a gait analysis. Single and dual-task gait was assessed by a 3D motion analysis system and the RoM data of the lower limb were extracted from hips, knees and ankles in the sagittal plane. Dual-task assignment was performed using word-color interference test. To compare both gait conditions, we used two different analyses: (1) common discrete analysis to provide lower limb RoM and (2) Statistical Parametric Mapping analysis (SPM) to provide lower limb joint kinematics. A correlation between lower limb RoM and spatiotemporal gait parameters was also performed for each gait condition. Results Common discrete analysis evidenced reductions in RoM of hips, knees and ankles during the dual task gait when compared to single gait. SPM analysis showed reductions in flexion-extension of hip, knees and ankles joints when dual task was compared to single task gait. These reductions were observed in specific gait events as toe off (for knees and ankles) and heel strike (for all joints). The reduction in lower limb RoM was positively correlated with the reduction in step length and gait speed. Conclusions Lower limb joints kinematics were reduced during toe off and heel strike in dual task gait when compared to single gait. These findings might help physiotherapists to understand the influence of dual and single walking in lower limb RoM throughout the gait cycle in people with PD and FOG.

Hypokinesia in Parkinson's disease: Influence of age, disease severity, and disease duration

1995 ◽  
Vol 10 (4) ◽  
pp. 424-432 ◽  
Author(s):  
J. J. van Hilten ◽  
E. A. M. Braat ◽  
E. A. van der Velde ◽  
H. A. M. Middelkoop ◽  
J. G. van Dijk ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Disease Severity ◽  
Disease Duration

scholarly journals Objective Gait and Balance Impairments Relate to Balance Confidence and Perceived Mobility in People With Parkinson Disease

2016 ◽  
Vol 96 (11) ◽  
pp. 1734-1743 ◽  
Author(s):  
Carolin Curtze ◽  
John G. Nutt ◽  
Patricia Carlson-Kuhta ◽  
Martina Mancini ◽  
Fay B. Horak
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson Disease ◽  
Disease Severity ◽  
Gait Speed ◽  
Stride Length ◽  
Inertial Sensors ◽  
Patient Perception ◽  
Objective Measures ◽  
Mobility Disability ◽  
Balance Confidence

Abstract Background Body-worn, inertial sensors can provide many objective measures of balance and gait. However, the objective measures that best reflect patient perception of mobility disability and clinician assessment of Parkinson disease (PD) are unknown. Objective The purposes of this study were: (1) to determine which objective measures of balance and gait are most related to patient perception of mobility disability and disease severity in people with PD and (2) to examine the effect of levodopa therapy on these correlates. Design This was an experimental correlation study. Methods One hundred four people with idiopathic PD performed 3 trials of the Instrumented Stand and Walk Test (ISAW) in the “on” and “off” medication states. The ISAW consists of quiet standing (30 seconds), gait initiation, straight walking (7 m), and turning (180°), yielding 34 objective measures of mobility from body-worn inertial sensors. Patient perception of mobility disability was assessed with the Activities-specific Balance Confidence (ABC) scale and the mobility subscale of the Parkinson's Disease Questionnaire (PDQ-39). Disease severity was assessed with the Unified Parkinson's Disease Rating Scale, part III (motor UPDRS). Spearman correlations were used to relate objective measures of mobility to patient perception and disease severity. Results Turning speed, gait speed, and stride length were most highly correlated to severity of disease and patient perception of mobility disability. The objective measures of mobility in the off-medication state were more indicative of patient perception of mobility disability and balance confidence compared with on-medication state measures. Limitations Causation is an inherent problem of correlation studies. Conclusion Physical therapists should evaluate mobility in people with PD in the off-medication state because the off-medication state is more related to disease severity and patient perception of mobility disability than the on-medication state mobility. Assessment and treatment of mobility in people with PD should target specific measures (ie, turning, gait speed, and stride length) because these measures best reflect patients' quality of life and balance confidence.

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