Dataset Information

Avoiding Virtual Obstacles During Treadmill Gait in Parkinson's Disease.

ABSTRACT: Falls often occur due to spontaneous loss of balance, but tripping over an obstacle during gait is also a frequent cause of falls (Sheldon, 1960; Stolze et al., 2004). Obstacle avoidance requires that appropriate modifications of the ongoing cyclical movement be initiated and completed in time. We evaluated the available response time to avoid a virtual obstacle in 26 Parkinson's disease (PD) patients (in the off-medication state) and 26 controls (18 elderly and 8 young), using a virtual obstacle avoidance task during visually cued treadmill walking. To maintain a stable baseline of stride length and visual attention, participants stepped on virtual "stepping stones" projected onto a treadmill belt. Treadmill speed and stepping stone spacing were matched to overground walking (speed and stride length) for each individual. Unpredictably, a stepping stone changed color, indicating that it was an obstacle. Participants were instructed to try to step short to avoid the obstacle. By using an obstacle that appeared at a precise instant, this task probed the time interval required for processing new information and implementing gait cycle modifications. Probability of successful avoidance of an obstacle was strongly associated with the time of obstacle appearance, with earlier-appearing obstacles being more easily avoided. Age was positively correlated (p < 0.001) with the time required to successfully avoid obstacles. Nonetheless, the PD group required significantly more time than controls (p = 0.001) to achieve equivalent obstacle-avoidance success rates after accounting for the effect of age. Slowing of gait adaptability could contribute to high fall risk in elderly and PD. Possible mechanisms may include disturbances in motor planning, movement execution, or disordered response inhibition.

SUBMITTER: Lu C

PROVIDER: S-EPMC6465417 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Avoiding Virtual Obstacles During Treadmill Gait in Parkinson's Disease.

Lu Chiahao C Twedell Emily E Elbasher Reem R McCabe Michael M MacKinnon Colum D CD Cooper Scott E SE

Frontiers in aging neuroscience 20190409

Falls often occur due to spontaneous loss of balance, but tripping over an obstacle during gait is also a frequent cause of falls (Sheldon, 1960; Stolze et al., 2004). Obstacle avoidance requires that appropriate modifications of the ongoing cyclical movement be initiated and completed in time. We evaluated the available response time to avoid a virtual obstacle in 26 Parkinson's disease (PD) patients (in the off-medication state) and 26 controls (18 elderly and 8 young), using a virtual obstacl ...[more]

PMID: 31024291

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Project description:BackgroundNo previous study has examined the age-dependent characteristics of gait in individuals between 50 and 79 years simultaneously in healthy individuals and individuals with Parkinson's disease (PD) over continuous gait cycles. This study aimed to investigate age-related differences in gait characteristics on individuals age ranged 50-79 years, including individuals with PD, during a 1-minute treadmill walking session. Additionally, we aimed to investigate the differences associated with spatiotemporal gait parameters and PD compared in age-matched individuals.MethodsThis study included 26 individuals with PD and 90 participants age ranged 50-79 years. The treadmill walking test at a self-preferred speed was performed for 1 min. The embedded inertial measurement unit sensor in the left and right outsoles-based system was used to collect gait characteristics based on tri-axial acceleration and tri-axial angular velocities.ResultsParticipants aged >60 years had a decreased gait speed and shortened stride and step, which may demonstrate a distinct shift in aging (all p < 0.005). Individuals with PD showed more of a decrease in variables with a loss of consistency, including gait asymmetry (GA), phase coordination index (PCI) and coefficient of variation (CV) of all variables, than age-matched individuals (all p < 0.001). Gait speed, stride and step length, stance phase, variability, GA and PCI were the variables that highly depended on age and PD.DiscussionOlder adults could be considered those older than 60 years of age when gait alterations begin, such as a decreased gait speed as well as shortened stride and step length. On the other hand, a loss of consistency in spatiotemporal parameters and a higher GA and PCI could be used to identify individuals with PD. Thus, the CV of all spatiotemporal parameters, GA and PCI during walking could play an important role and be useful in identifying individuals with PD.ConclusionThis study provided the notable aging pattern characteristics of gait in individuals >50 years, including individuals with PD. Increasing age after 60 years is associated with deterioration in spatiotemporal parameters of gait during continuous 1-minute treadmill walking. Additionally, GA, PCI and the CV of all variables could be used to identify PD which would be placed after 70 years of age. It may be useful to determine the decline of gait performance in general and among individuals with PD.

Project description:BackgroundGait problems are critical impairments in Parkinson's disease (PD) and are related to increased risk of fall and negatively impact activities of daily life. Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that can modify the cortical excitability of gait-related brain regions. In this study, we investigated whether multichannel tDCS with simultaneous treadmill gait training could improve gait in PD.MethodsTwenty-four patients with PD were assigned randomly to a real or sham tDCS group. Before intervention, one patient of the real tDCS group was dropped out, leaving 23 patients to be analyzed in this study. Each patient underwent 30 min of treadmill gait training for 10 sessions over four consecutive weeks. Multichannel 4x1 tDCS was applied using five 6-cm-diameter round electrodes. One anode was placed on the CZ, and four cathodes were positioned symmetrically over the FZ, C5, C6, and PZ. Anodal tDCS (2mA) and sham tDCS were delivered for 20 min. The secondary outcomes were gait performance, as measured by the timed up and go test (TUG) and freezing of gait questionnaire (FOG-Q), and balance was assessed using the dynamic gait index (DGI), Berg balance scale (BBS), and functional reach test (FRT). Motor and non-motor performance of patients with PD were assessed using the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS). Participants were assessed before the intervention, immediately after the intervention, and 4 weeks after completion of the intervention.ResultsThe real tDCS group showed a significant improvement in the 10-m walk test, but the sham group did not. Among the secondary outcome measures, MDS-UPDRS part II, TUG, and BBS were improved only in the real tDCS group. Particularly, MDS-UPDRS part II showed a significant group*time interaction effect, indicating that real tDCS demonstrated a better effect on the activities of daily living patients with PD.ConclusionsThe results of this pilot study suggest that multichannel tDCS applied on the leg motor cortex during treadmill gait training is a safe and effective means to improve gait velocity in patients with PD. Additional rigorous, large-sample, multicenter, randomized controlled trials are needed to confirm the effect of tDCS as a therapeutic adjunct for gait rehabilitation of patients with PD.

Dataset Information

Avoiding Virtual Obstacles During Treadmill Gait in Parkinson's Disease.

Publications

Avoiding Virtual Obstacles During Treadmill Gait in Parkinson's Disease.

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