Comparison of Shod and Unshod Gait in Patients With Parkinson's Disease With Subthalamic and Nigral Stimulation

Background: The Parkinsonian [i.e., Parkinson's disease (PD)] gait disorder represents a therapeutical challenge with residual symptoms despite the use of deep brain stimulation of the subthalamic nucleus (STN DBS) and medical and rehabilitative strategies. The aim of this study was to assess the effect of different DBS modes as combined stimulation of the STN and substantia nigra (STN+SN DBS) and environmental rehabilitative factors as footwear on gait kinematics.Methods: This single-center, randomized, double-blind, crossover clinical trial assessed shod and unshod gait in patients with PD with medication in different DBS conditions (i.e., STIM OFF, STN DBS, and STN+SN DBS) during different gait tasks (i.e., normal gait, fast gait, and gait during dual task) and compared gait characteristics to healthy controls. Notably, 15 patients participated in the study, and 11 patients were analyzed after a dropout of four patients due to DBS-induced side effects.Results: Gait was modulated by both factors, namely, footwear and DBS mode, in patients with PD. Footwear impacted gait characteristics in patients with PD similarly to controls with longer step length, lower cadence, and shorter single-support time. Interestingly, DBS exerted specific effects depending on gait tasks with increased cognitive load. STN+SN DBS was the most efficient DBS mode compared to STIM OFF and STN DBS with intense effects as step length increment during dual task.Conclusion: The PD gait disorder is a multifactorial symptom, impacted by environmental factors as footwear and modulated by DBS. DBS effects on gait were specific depending on the gait task, with the most obvious effects with STN+SN DBS during gait with increased cognitive load.

Correlation of Dopaminergic Denervation and the Progression of Autonomic Dysfunctions in Different Clinical Subtypes of Parkinson’s Disease

Background. Autonomic dysfunctions occur in the early stage of Parkinson’s disease (PD) and impact the quality of life during the progression of the disease. In this study, we evaluated the serial progression of autonomic dysfunctions between different subtypes of a prospective PD cohort. Materials and Methods. From the Parkinson’s Progression Markers Initiative (PPMI) database, 325 PD patients (age: 61.2 ± 9.7, M : F = 215 : 110) were enrolled. Patients were subgrouped into tremor-dominant (TD), indeterminate, and postural instability and gait disorder (PIGD) subtypes. The progression of autonomic dysfunctions and dopaminergic denervation from I-123 FP-CIT SPECT images of each group were analyzed and compared at baseline, 12 months, 24 months, and 48 months of follow-up periods. Results. The SCOPA-AUT score of the indeterminate subtype was significantly higher than that of the TD subtype ( P < 0.05 ) at baseline and was significantly higher than that of both TD and PIGD subtypes ( P < 0.05 ) at 48 months. The indeterminate subtype had the most significant correlation between the aggravation of dopaminergic denervation in I-123 FP-CIT SPECT images and the increase of SCOPA-AUT scores during 48 months of follow-up (r = 0.56, P < 0.01 ). Conclusions. Autonomic dysfunctions were most severe in the indeterminate subtype throughout the 48 months of the follow-up period, with a significant correlation with dopaminergic denervation. We suggest a positive relationship between dopaminergic denervation and autonomic dysfunctions of the indeterminate subtype, beginning from the early stage of PD.

Gait Disorder Detection and Classification Method Using Inertia Measurement Unit for Augmented Feedback Training in Wearable Devices

Parkinson’s disease (PD) is a common neurodegenerative disease, one of the symptoms of which is a gait disorder, which decreases gait speed and cadence. Recently, augmented feedback training has been considered to achieve effective physical rehabilitation. Therefore, we have devised a numerical modeling process and algorithm for gait detection and classification (GDC) that actively utilizes augmented feedback training. The numerical model converted each joint angle into a magnitude of acceleration (MoA) and a Z-axis angular velocity (ZAV) parameter. Subsequently, we confirmed the validity of both the GDC numerical modeling and algorithm. As a result, a higher gait detection and classification rate (GDCR) could be observed at a higher gait speed and lower acceleration threshold (AT) and gyroscopic threshold (GT). However, the pattern of the GDCR was ambiguous if the patient was affected by a gait disorder compared to a normal user. To utilize the relationships between the GDCR, AT, GT, and gait speed, we controlled the GDCR by using AT and GT as inputs, which we found to be a reasonable methodology. Moreover, the GDC algorithm could distinguish between normal people and people who suffered from gait disorders. Consequently, the GDC method could be used for rehabilitation and gait evaluation.

Conceptual Design of a Compliant Hip Orthosis for Trendelenburg Gait

Weakness of the hip abduction muscles can result in a gait disorder named Trendelenburg gait, which can lead to problems in the hip joint, knees, and ankles. In this paper, the conceptual design of a compliant hip orthosis to prevent Trendelenburg gait is presented. A theoretical analysis and measurements on a technical prototype show a high stiffness ratio between adduction and flexion-extension of the leg, and minimal shear forces from the orthosis on the human body while staying close to the human body.

Normal Pressure Hydrocephalus Associated with COVID-19 Infection: A Case Report

COVID-19 is a pandemic disease responsible for a large number of deaths worldwide. Many neurological manifestations have been described. We report a case of normal pressure hydrocephalus (NPH) two months after acute COVID19 infection, in a patient without other risk factors. A 45-year-old male patient presented an 8-month history of progressive gait disorder and cognitive impairment after being hospitalized for SARS-CoV-2 infection. Magnetic resonance imaging (MRI) was compatible with NPH. A spinal tap test was positive and there was progressive improvement after shunting, with complete resolution of symptoms. Other infections such Syphilis, cryptococcosis and Lyme disease have been associated with NPH. Possible mechanisms for NPH after COVID include disruption of choroid plexus cells by direct viral invasion or as a result of neuroinflammation and cytokine release and hypercoagulability leading to venous congestion and abnormalities of CSF flow. Given the significance of NPH as a cause of reversible dementia, it is important to consider the possibility of a causal association with COVID19 and understand the mechanisms behind this association.

Mutation in the CREBBP Gene in the Girl with Toe Walking Syndrome: Clinical Case

Background. Pathogenic variants of the CREBBP gene have been revealed in patients with Rubinstein–Taybi and Menke–Hennekam syndromes, however, the toe walking symptom was not mentioned in these pathologies.Clinical Case Description. The pathogenic nucleotide variant c.5600G>A in heterozygous state in the CREBBP gene was revealed in our 9-year-old female patient with refractory toe walking and developmental speech delay. There were no abnormalities typical for Rubinstein–Taybi syndrome, but there were several signs of Menke–Hennekam syndrome.Conclusion. The genetic anomaly associated with toe walking is described. This observation allows us to critically relate to the hypothesis about the idiopathic genesis of this form of gait disorder at the absence of obvious neurological or orthopedic causes of its development.

Does Subthalamic Deep Brain Stimulation Impact Asymmetry and Dyscoordination of Gait in Parkinson’s Disease?

BackgroundSubthalamic deep brain stimulation is an effective treatment for selected Parkinson’s disease patients. Axial deficits including postural stability and gait characteristics are often altered after surgery, but quantitative gait-related therapeutic effects are poorly described.ObjectiveThe goal of this study was to systematically investigate modifications in asymmetry and dyscoordination of gait six-months post-operatively in patients with Parkinson’s disease, and compare the outcomes with preoperative baseline and to asymptomatic controls.MethodsThirty-two patients with Parkinson’s disease (19 with postural instability and gait disorder type, 13 with tremor-dominant disease) and 51 asymptomatic controls participated. Parkinson patients were tested prior to the surgery in both OFF and ON medication states, and six months post-operatively in the ON stimulation condition. Clinical outcome parameters and medication were compared to preoperative conditions. Asymmetry ratios, phase coordination index, and walking speed were assessed.ResultsPatients’ clinical outcomes as assessed by standard clinical parameters at six-months improved significantly, and levodopa-equivalent daily dosages were significantly decreased. STN-DBS increased step time asymmetry (hedges’ g effect sizes [confidence intervals] between pre- and post-surgery: 0.27 [-0.13,0.73]) and phase coordination index (0.29 [-0.08,0.67]). These effects were higher in the Postural Instability and Gait Disorder subgroup than the Tremor Dominant (step time asymmetry: 0.38 [-0.06,0.90] vs. 0.09 [-0.83,1.0] and phase coordination index: 0.39 [-0.04,0.84] vs. 0.13 [-0.76,0.96]).ConclusionThis study provides objective evidence of how subthalamic deep brain stimulation increases asymmetry and dyscoordination of gait in patients with Parkinson’s disease, and suggests motor subtypes-associated differences in the treatment response.

Assessment of Gait Disorder in Parkinson's Disease

Neurological disorders are some of the leading chronic disorders that impose a massive burden on low-income and developing countries. The disability resulting from the neurological disorder increases the severity and costs during the primary healthcare and for entire lifetime. Parkinson's disease (PD) is the second most common chronic neurodegenerative disorder which is slowly progressive with decrease in the motor and non-motor function of the nervous system due to cognitive impairment leading to gait abnormality. PD is most common in the age group of 40-65years leading to increase in gait disorders associated with slowing down of the movement, balance instability, rigidness in the muscles, and difficulty in performing everyday tasks. The assessment of gait plays a significant role in maintaining the balance disorders in Parkinson's disease. In patients with PD, the neurons present in substantia nigra region of the brain get injured, and they progressively decline during their lifetime. Therefore, the patients lose their ability to perform movement and also lose their stability. The symptoms of PD can be monitored and controlled by assessing gait parameters based on gait disorder.