Longitudinal changes over thirty-six months in postural control dynamics and cognitive function in people with Parkinson's disease

Pantall, Annette; Din, Silvia Del; Rochester, Lynn

doi:10.1016/j.gaitpost.2018.04.016

Cited by 26 publications

(27 citation statements)

References 40 publications

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“…This finding is supported by a study that reported decreased AP sway during standing in people with PD compared to controls (50). A recent study analyzing postural data from a similar cohort of individuals with PD observed increased regularity of postural dynamics from 18 to 54 months along the AP axis suggesting possible modification of motor control along this axis (56). The reduction in AP postural dynamics may result from greater instability in the AP direction, associated with decreased knee flexion and greater difficulty initiating ankle dorsiflexion to maintain balance (57).…”

Section: Discussionmentioning

confidence: 99%

Postural Dynamics Are Associated With Cognitive Decline in Parkinson's Disease

et al. 2018

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Early features of Parkinson's disease (PD) include both motor and cognitive changes, suggesting shared common pathways. A common motor dysfunction is postural instability, a known predictor of falls, which have a major impact on quality of life. Understanding mechanisms of postural dynamics in PD and specifically how they relate to cognitive changes is essential for developing effective interventions. The aims of this study were to examine the changes that occur in postural metrics over time and explore the relationship between postural and cognitive dysfunction. The study group consisted of 35 people (66 ± 8years, 12 female, UPDRS III: 22.5 ± 9.6) diagnosed with PD who were recruited as part of the Incidence of Cognitive Impairment in Cohorts with Longitudinal Evaluation—PD Gait (ICICLE-GAIT) study. Postural and cognitive assessments were performed at 18, 36, and 54 months after enrolment. Participants stood still for 120 s, eyes open and arms by their side. Postural dynamics were measured using metrics derived from a single tri-axial accelerometer (Axivity AX3, York, UK) on the lower back. Accelerometry metrics included jerk (derivative of acceleration), root mean square, frequency, and ellipsis (acceleration area). Cognition was evaluated by neuropsychological tests including the Montreal Cognitive Assessment (MoCA) and digit span. There was a significant decrease in accelerometry parameters, greater in the anteroposterior direction, and a decline in cognitive function over time. Accelerometry metrics were positively correlated with lower cognitive function and increased geriatric depression score and negatively associated with a qualitative measure of balance confidence. In conclusion, people with PD showed reduced postural dynamics that may represent a postural safety strategy. Associations with cognitive function and depression, both symptoms that may pre-empt motor symptoms, suggest shared neural pathways. Further studies, involving neuroimaging, may determine how these postural parameters relate to underlying neural and clinical correlates.

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Section: Discussionmentioning

confidence: 99%

Postural Dynamics Are Associated With Cognitive Decline in Parkinson's Disease

et al. 2018

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“…Linear parameters and derived indexes provide information about the direction (e.g., anterior–posterior or mediolateral directions) and global ‘magnitude’ of postural sway (e.g., root mean square (RMS), limits of stability, jerk, ellipsis), and the fluctuation of COM or COP displacement (frequency domain metrics) [45,46,47,48,49,50,51,52]. Non-linear outcomes describe the regularity or predictability of balance control [53].…”

Section: Section I: Quantitative Movement Analysis: From Measuremementioning

confidence: 99%

“…The protocols that are used to assess postural control vary greatly from quiet standing to standing barefoot or with shoes on, on a foam support or firm surface, with eyes open or closed (Romberg test), with either standardised or unrestricted foot placement, with arms across the chest or by their sides, and over different trial durations ranging from 30 to 120 seconds [48,51,53,54,55,56]. To date, postural control outcomes are typically summarised over the test duration, which may limit comparability across protocols of varied duration, as most linear metrics are time-dependent and thus influenced by test duration.…”

Section: Section I: Quantitative Movement Analysis: From Measuremementioning

confidence: 99%

The Role of Movement Analysis in Diagnosing and Monitoring Neurodegenerative Conditions: Insights from Gait and Postural Control

et al. 2019

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Quantifying gait and postural control adds valuable information that aids in understanding neurological conditions where motor symptoms predominate and cause considerable functional impairment. Disease-specific clinical scales exist; however, they are often susceptible to subjectivity, and can lack sensitivity when identifying subtle gait and postural impairments in prodromal cohorts and longitudinally to document disease progression. Numerous devices are available to objectively quantify a range of measurement outcomes pertaining to gait and postural control; however, efforts are required to standardise and harmonise approaches that are specific to the neurological condition and clinical assessment. Tools are urgently needed that address a number of unmet needs in neurological practice. Namely, these include timely and accurate diagnosis; disease stratification; risk prediction; tracking disease progression; and decision making for intervention optimisation and maximising therapeutic response (such as medication selection, disease staging, and targeted support). Using some recent examples of research across a range of relevant neurological conditions—including Parkinson’s disease, ataxia, and dementia—we will illustrate evidence that supports progress against these unmet clinical needs. We summarise the novel ‘big data’ approaches that utilise data mining and machine learning techniques to improve disease classification and risk prediction, and conclude with recommendations for future direction.

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“…These instrumented tests provide an array of quantitative features that can distinguish specific characteristics of motor function in individuals with PD [ 18 , 25 – 29 ]. Similarly, studies have used accelerometry (ACC) to analyse postural control in individuals with PD [ 30 – 32 ], and to investigate differences in features of the gait cycle between PD and healthy control subjects, such as step time, swing time and stride time [ 27 , 28 , 33 , 34 ]. While these studies highlight the advantages of instrumenting clinical tests to examine patient mobility, there remains a dearth of research incorporating body-worn sensors to monitor and quantitatively assess adaptations in motor function occurring at various stages of physical therapy.…”

Section: Introductionmentioning

confidence: 99%

Quantitative clinical assessment of motor function during and following LSVT-BIG® therapy

Flood

O’Callaghan

Diamond

et al. 2020

J NeuroEngineering Rehabil

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Background LSVT-BIG® is an intensively delivered, amplitude-oriented exercise therapy reported to improve mobility in individuals with Parkinson’s disease (PD). However, questions remain surrounding the efficacy of LSVT-BIG® when compared with similar exercise therapies. Instrumented clinical tests using body-worn sensors can provide a means to objectively monitor patient progression with therapy by quantifying features of motor function, yet research exploring the feasibility of this approach has been limited to date. The aim of this study was to use accelerometer-instrumented clinical tests to quantify features of gait, balance and fine motor control in individuals with PD, in order to examine motor function during and following LSVT-BIG® therapy. Methods Twelve individuals with PD undergoing LSVT-BIG® therapy, eight non-exercising PD controls and 14 healthy controls were recruited to participate in the study. Functional mobility was examined using features derived from accelerometry recorded during five instrumented clinical tests: 10 m walk, Timed-Up-and-Go, Sit-to-Stand, quiet stance, and finger tapping. PD subjects undergoing therapy were assessed before, each week during, and up to 13 weeks following LSVT-BIG®. Results Accelerometry data captured significant improvements in 10 m walk and Timed-Up-and-Go times with LSVT-BIG® ( p < 0.001), accompanied by increased stride length. Temporal features of the gait cycle were significantly lower following therapy, though no change was observed with measures of asymmetry or stride variance. The total number of Sit-to-Stand transitions significantly increased with LSVT-BIG® ( p < 0.001), corresponding to a significant reduction of time spent in each phase of the Sit-to-Stand cycle. No change in measures related to postural or fine motor control was observed with LSVT-BIG®. PD subjects undergoing LSVT-BIG® showed significant improvements in 10 m walk ( p < 0.001) and Timed-Up-and-Go times ( p = 0.004) over a four-week period when compared to non-exercising PD controls, who showed no week-to-week improvement in any task examined. Conclusions This study demonstrates the potential for wearable sensors to objectively quantify changes in motor function in response to therapeutic exercise interventions in PD. The observed improvements in accelerometer-derived features provide support for instrumenting gait and sit-to-stand tasks, and demonstrate a rescaling of the speed-amplitude relationship during gait in PD following LSVT-BIG®.

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Longitudinal changes over thirty-six months in postural control dynamics and cognitive function in people with Parkinson's disease

Abstract: People with PD exhibit decreased regularity of trunk dynamics when standing compared to HOAs. Nonlinear accelerometer metrics along all three axes are therefore a potential biomarker of PD. The relationship between trunk dynamics and cognitive function indicates common neural pathways.

Cited by 26 publications

References 40 publications

Postural Dynamics Are Associated With Cognitive Decline in Parkinson's Disease

Postural Dynamics Are Associated With Cognitive Decline in Parkinson's Disease

The Role of Movement Analysis in Diagnosing and Monitoring Neurodegenerative Conditions: Insights from Gait and Postural Control

Quantitative clinical assessment of motor function during and following LSVT-BIG® therapy

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