24-Hour Recording of Parkinsonian Gait Using a Portable Gait Rhythmogram

Abstract

Objective In the advanced stage of Parkinson's disease (PD), motor fluctuation is a frequent and a disabling problem. Despite its importance, motor fluctuation has received little scientific analysis probably due to limitation in objective assessment. Here, we focused on gait disorders to estimate motor fluctuation in daily activities. Patients and Methods Using a new device, the portable gait rhythmogram, we recorded gait rhythm continuously over 24 hours in 22 patients with PD and in 11 normal controls, for quantitative evaluation of motor fluctuation. The duration of one gait cycle was measured. Results Continuous 24-hour recording identified changes in gait rhythm, which correlated with fluctuation of PD symptoms. Different motor fluctuations were observed; a shift to a faster gait cycle was noted in patients with short-step walking, festination or freezing of gait, whereas a shift to a slower gait cycle was observed in patients with bradykinesia or instability. Conclusion Characterization of motor fluctuation using this device could help in the selection of appropriate anti-PD medications.

A Newly Developed Wearable Device for Continuous Measurement of Gait- Induced Accelerations in Daily Activities

“…3) Severe disturbance of the center involved in the control of the step cycle is associated with failure of compensation, leading to bradykinesia. Consistent with this hypothesis, we reported previously slowing of the gait cycle during the wearing-off period in patients with prominent bradykinesia [13,17]. The results also suggest that the gait cycle and acceleration of gait movements are controlled independently and that disturbances in these movements exhibit different clinical courses in PD.…”

“…The PGR is a trunk-mounted small device (size, 8×6×2 cm, weight, 80 g) ( Figure 1) housing an acceleration sensor with automatic gait detection algorithm, in which gait induced-accelerations are extracted from limb and trunk movements using a mathematical algorithm; the "pattern matching method" [13][14][15][16][17][18][19][20]. …”

“…Based on the capability of the PGR for long-term monitoring, we monitored changes in gait abilities in PD patients. The continuous recording provided new findings on motor fluctuation in PD [13,19]. Dopamine-replacement therapy at the early stage of PD decreases motor and non-motor complications.…”

“…The PGR measures three dimensionally (ax, ay, az) 1) accelerations associated with limb and trunk movements, and 2) accelerations induced by step-in and kick-off during gait [13][14][15][16]. The PGR is attached to the waist of the patient, and records the above signals at a sampling rate of 10 msec.…”

“…The acceleration vectors associated with stepping can be distinguished from those associated with other limb and trunk movements or with unexpected artifacts, based on the mathematical method of "pattern matching", as reported in detail previously [13][14][15][16]. First, attention is focused on relatively strong signal region (e.g., a>1 m/s 2 ) in the acceleration time series, and a three-dimensional template wave (ax, ay, az) with a duration of about 0.5 sec is arbitrarily chosen.…”