Gait dynamics in Parkinson's disease: relationship to Parkinsonian features, falls and response to levodopa

Schaafsma, Joanna D.; Giladi, Nir; Balash, Yacov; Bartels, Anna L.; Gurevich, Tanya; Hausdorff, Jeffrey M.

doi:10.1016/s0022-510x(03)00104-7

Cited by 379 publications

(373 citation statements)

References 25 publications

Supporting

Mentioning

328

Contrasting

Unclassified

Order By: Relevance

“…Taken together, the presence of axial bradykinesia likely represents a key element of MPS responsible for abnormal gait performance in normal aging. In addition, the similarity of the present investigation, linking bradykinesia and quantitative gait parameters, with previous PD studies (Morris et al 1994;Schaafsma et al 2003) suggests a deficit in the nigral pathway. In support, a recent clinicopathological study reported that nigral neuronal loss was associated with the presence of MPS in aging (Buchman et al 2012).…”

Section: Discussionsupporting

confidence: 90%

See 1 more Smart Citation

Contributions of mild parkinsonian signs to gait performance in the elderly

Allali

Mahoney

2014

AGE

View full text Add to dashboard Cite

Mild parkinsonian signs (MPS) and gait abnormalities are common in aging, but the association between MPS and objective gait measures is not established in the elderly. This study aims to identify the link between MPS and quantitative gait measures, as well as to determine the pathogenesis of MPS in nondemented community-dwelling older adults without idiopathic Parkinson's disease or other parkinsonian syndromes. Three hundred seventy-four non-demented older adults (mean age, 76.44±6.71 years, 57 % women) participated in this study, where comprehensive neurological and medical assessments were conducted. We defined MPS based on the presence of any one of bradykinesia, rigidity, or rest tremor. Velocity and spatial, temporal, and variability gait parameters were recorded using an instrumented walkway. The associations of MPS and gait parameters as well as the relationship of individual MPS with medical illnesses were assessed with linear regressions controlling for key covariates. Participants with MPS walked slower and with disturbed spatial and variability components of gait compared to those without MPS. Bradykinesia was associated with worse spatial and variability gait parameters. This association was only significant for axial bradykinesia, but not for the presence of bradykinesia in the limbs. Cerebrovascular disease (β=.20, p<.01) was associated with bradykinesia, whereas cardiovascular disease (β=.15, p<.05) was associated with rigidity. Among MPS, bradykinesia but not rigidity or tremor was associated with worse quantitative gait performance in older adults. Cerebrovascular disease, a preventable condition, was specifically associated with bradykinesia.

show abstract

Section: Discussionsupporting

confidence: 90%

“…Furthermore, bradykinesia has been associated with stride time variability during "on" but not "off" state," which suggests an association with levodopa integrity (Schaafsma et al 2003). Concerning the dopaminergic pathway, both bradykinesia and PIGD have been associated with [ 123 I]β-CIT SPECT binding in patients with PD (Pirker 2003).…”

Section: Discussionmentioning

confidence: 99%

Contributions of mild parkinsonian signs to gait performance in the elderly

Allali

Mahoney

2014

AGE

View full text Add to dashboard Cite

show abstract

“…Participants were tested under the following conditions: 1) Baseline: (usual walking for 100 meters); 2) RAS set to each participant's normal cadence; 3) Usual walking (to assess any carryover effect); 4) RAS set to 110% of usual cadence; 5) Usual walking (to assess immediate carryover effect); and 6) Usual walking 15 min later (to assess longer carryover). As in previous studies (Blin et al, 1990;Hausdorff et al, 1998;Hausdorff et al, 2000;Schaafsma et al, 2003), both stride time variability and swing time variability were significantly increased in the participants with PD compared to the controls under usual walking conditions (p < .01). When RAS was set to each participant's usual cadence, the variability of the stride time and swing time tended to decrease among the participants with PD, but the effect was not significant.…”

Section: Rhythmic Auditory Stimulation (Ras) Improves Gait Rhythmicitsupporting

confidence: 83%

“…In general, however, the relationships between gait variability, fall risk, and other parkinsonian features were not wellstudied and the effect of levodopa on falls and gait variability were also largely unknown. To better understand the effects of PD on walking, especially gait instability, and the factors that contribute to gait variability and fall risk in PD, we studied patients with idiopathic PD in order to evaluate: (1) the relationship between gait variability, fall history and other parkinsonian features, and (2) the effect of levodopa on gait variability and fall frequency (Schaafsma et al, 2003). Forty-one percent of these patients reported a history of falls.…”

Section: Gait Variability and Fall Risk In Parkinson's Disease (Pd)mentioning

confidence: 99%

“…Further, one could suggest that because RAS sets the pace, it can act like an external rhythm generator and help to restore neurally controlled rhythmicity, thereby reducing stride-to-stride variability. Conversely, in PD, gait rhythmicity and stride variability often behave differently from stride length, gait speed, and other parkinsonian features (Hausdorff, 2005;FrenkelToledo et al, 2005a;Blin et al, 1991;Hausdorff et al, 1998;Schaafsma et al, 2003). Thus, one could suggest that while RAS restores the ability of PD patients to generate a 'normal' stride length, damage to the circuits that regulate rhythmicity may prevent these patients from walking with a consistent pattern, even in the presence of RAS.…”

Section: Rhythmic Auditory Stimulation (Ras) Improves Gait Rhythmicitmentioning

confidence: 99%

See 1 more Smart Citation

Gait dynamics, fractals and falls: Finding meaning in the stride-to-stride fluctuations of human walking

Hausdorff

2007

Human Movement Science

Self Cite

707

594

View full text Add to dashboard Cite

Until recently, quantitative studies of walking have typically focused on properties of a typical or average stride, ignoring the stride-to-stride fluctuations and considering these fluctuations to be noise. Work over the past two decades has demonstrated, however, that the alleged noise actually conveys important information. The magnitude of the stride-to-stride fluctuations and their changes over time during a walk -gait dynamics -may be useful in understanding the physiology of gait, in quantifying age-related and pathologic alterations in the locomotor control system, and in augmenting objective measurement of mobility and functional status Indeed, alterations in gait dynamics may help to determine disease severity, medication utility, and fall risk, and to objectively document improvements in response to therapeutic interventions, above and beyond what can be gleaned from measures based on the average, typical stride. This review discusses support for the idea that gait dynamics has meaning and may be useful in providing insight into the neural control of locomtion and for enhancing functional assessment of aging, chronic disease, and their impact on mobility.

show abstract

Cortical Correlates of Gait Compensation Strategies in Parkinson Disease

Tosserams

Weerdesteyn

Bal

et al. 2022

Annals of Neurology

View full text Add to dashboard Cite

Objective Gait impairment in persons with Parkinson disease is common and debilitating. Compensation strategies (eg, external cues) are an essential part of rehabilitation, but their underlying mechanisms remain unclear. Using electroencephalography (EEG), we explored the cortical correlates of 3 categories of strategies: external cueing, internal cueing, and action observation. Methods Eighteen participants with Parkinson disease and gait impairment were included. We recorded 126‐channel EEG during both stance and gait on a treadmill under 4 conditions: (1) uncued, (2) external cueing (listening to a metronome), (3) internal cueing (silent rhythmic counting), and (4) action observation (observing another person walking). To control for the effects of sensory processing of the cues, we computed relative power changes as the difference in power spectral density between walking and standing for each condition. Results Relative to uncued gait, the use of all 3 compensation strategies induced a decrease of beta band activity in sensorimotor areas, indicative of increased cortical activation. Parieto‐occipital alpha band activity decreased with external and internal cueing, and increased with action observation. Only internal cueing induced a change in frontal cortical activation, showing a decrease of beta band activity compared to uncued gait. Interpretation The application of compensation strategies resulted in changed cortical activity compared to uncued gait, which could not be solely attributed to sensory processing of the cueing modality. Our findings suggest there are multiple routes to control gait, and different compensation strategies seem to rely on different cortical mechanisms to achieve enhanced central motor activation in persons with Parkinson disease. ANN NEUROL 2022;91:329–341

show abstract

Gait dynamics in Parkinson's disease: relationship to Parkinsonian features, falls and response to levodopa

Cited by 379 publications

References 25 publications

Contributions of mild parkinsonian signs to gait performance in the elderly

Contributions of mild parkinsonian signs to gait performance in the elderly

Gait dynamics, fractals and falls: Finding meaning in the stride-to-stride fluctuations of human walking

Cortical Correlates of Gait Compensation Strategies in Parkinson Disease

Contact Info

Product

Resources

About