Independent Regulation of the Cycle and Acceleration in Parkinsonian Gait Analyzed by a Long-Term Daily Monitoring System

Abstract

Background: Few reports have objectively assessed gait patterns of Parkinson’s disease (PD) patients in their daily lives. We investigated the mean gait cycle and mean gait acceleration using a portable gait rhythmogram (PGR). Method: We continuously recorded PGR measurements for 24 h in 64 PD patients with the ability to independently engage in activities of daily living. Results: There was no significant difference in the mean gait cycle between PD patients and normal controls. However, the mean gait cycle was significantly faster in PD patients in the modified Hoehn and Yahr stage 1.5 than those in stages 2.5–3.0. The mean gait acceleration in PD patients was significantly less than in normal controls, but there were no significant differences among the stage groups. Conclusion: The results suggest that the cycle and acceleration of gait movements are controlled independently and that disturbances in these movements have different clinical courses in PD.

Relationship between Amount of Daily Movement Measured by a Triaxial Accelerometer and Motor Symptoms in Patients with Parkinson’s Disease

“…The MIMAMORI-Gait is a portable motion recorder designed for long-term continuous measurement, and has been approved in Japan for clinical assessment of gait disturbance and the amount of movement in patients with various diseases-such as PD, progressive supranuclear palsy, and vascular parkinsonism-and has been confirmed to be useful clinically [12][13][14][15]26]. The present study was carried out to determine the association between the amount of overall movement over the 24 h measured by the MIMAMORI-Gait and motor symptoms of patients with PD assessed at the outpatient clinic by the UPDRS.…”

“…This device is mainly used for the assessment of the amount of overall movement and gait in patients with PD and other neurodegenerative disorders [12][13][14][15]. The amount of overall movement measured with MIMAMORI-Gait is assumed to quantify akinesia/bradykinesia, composite symptoms, combined with elemental motor deficit [12][13][14][15].…”

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

“…The results highlighted new aspects of disturbances of the gait control centers with advancement in PD [20]. PGR was recorded continuously over 24 hours in 64 PD independent patients who engaged in activities of daily living, and 17 age-matched controls.…”

“…In a series of studies, Morris et al [21][22][23] proposed that a decrease in stride length was an important change in parkinsonian walking and that PD patients walk with a faster gait cycle to maintain overall speed. Based on this concept of compensatory changes, the results reported in our previous study [20] could be explained as follows: 1) while the control center for the step cycle is preserved (at the early stage, mH&Y stage 1.5), efficient compensation occurs, that is, shortness of stride is compensated by cycle acceleration. 2) moderate disturbance of the center responsible for the control of the step cycle (i.e., as seen in patients with mH&Y stages 2.0-3.0), results in difficulties in speeding up the gait cycle due to lack of efficient compensation, and thus the gait cycle in these patients would be similar to that of the normal subjects.…”

“…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]. …”