An objective assessment to investigate the impact of turning angle on freezing of gait in Parkinson's disease (original) (raw)
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International Journal of Environmental Research and Public Health
For people with Parkinson’s disease (PD) with freezing of gait (FOG) (freezers), symptoms mainly exhibit as unilateral motor impairments that may cause difficulty during postural transitions such as turning during daily activities. We investigated the turning characteristics that distinguished freezers among people with PD and analyzed the association between the New Freezing of Gait Questionnaire (NFOGQ) scores and the gait characteristics according to the turning direction for the affected limbs of freezers. The study recruited 57 people with PD (27 freezers, 30 non-freezers). All experiments measured the maximum 180° turning task with the “Off” medication state. Results revealed that the outer ankle range of motion in the direction of the inner step of the more affected limb (IMA) was identified to distinguish freezers and non-freezers (RN2 = 0.735). In addition, higher NFOGQ scores were associated with a more significant anteroposterior root mean square distance of the center of...
2020
This study investigated the turning characteristics of the more-affected limbs in Parkinson’s disease (PD) patients in comparison with that of a control group, and in PD patients with freezing of gait (FOG; freezers) in comparison with those without FOG (non-freezers) for 360° and 540° turning tasks at the maximum speed. A total of 12 freezers, 12 non-freezers, and 12 controls participated in this study. The PD patients showed significantly longer total durations, shorter inner and outer step lengths, and greater anterior–posterior (AP) root mean square (RMS) center of mass (COM) distances compared to those for the controls. The freezers showed significantly greater AP and medial-lateral (ML) RMS COM distances compared to those of non-freezers. The turning task toward the inner step of the more-affected side (IMA) in PD patients showed significantly greater step width, total steps, and AP and ML RMS COM distances than that toward the outer step of the more-affected side (OMA). The c...
Clinical indicators of gait freezing in Parkinson's disease
2020
Background: Freezing of gait is a common (FOG) episodic gait disorder in advanced Parkinson's disease (PD). FOG is one of the main risk factors for falls; therefore FOG's consequences can be devastating. This symptom is difficult to study in a research laboratory because of its unpredictability which makes it difficult to select patients for clinical testing and make the right treatment decisions. Thus, clinical indicators may be useful to distinguish between patients with and without FOG. The aim of this study was to compare the number of steps and the time to perform a 180-degree turn in patients with Parkinson's disease with and without FOG. Material and methods: The study was performed on 56 PD patients. Subjects were divided into 2 groups: a total of 28 patients with PD and FOG were compared with 28 patients with PD without FOG, according to item number 14, from the Unified Parkinson's Disease Rating Scale (UPDRS). The 2 subgroups were homogeneous in terms of age and disease severity. Results: Significant differences were found between the two groups both in steps number (P <0.0001) and in the time required to perform a 180-degree turn (P <0.0001). Conclusions: Performing more steps and more seconds to turn 180 degrees may be a useful indicator to distinguish the characteristics of PD patients with FOG. A PD patient which turns at 180-degree with more than 5 steps is most likely a patient with FOG.
International Journal of Gerontology, 2016
Background: This study aimed to evaluate the effects of cueing on circular walking in patients with Parkinson's disease. Methods: Parkinson's disease patients in the "off" state were asked to walk on a designed route at their preferred speed. The experimental protocol was divided into two sessions. The first session was to be performed with no manual task. During the second session, the participant had to perform a manual task. Each session was measured for each of four conditions performed in the following order: without cues, with a visual cue, with an auditory cue, and with dual cues simultaneously. Temporospatial gait parameters and freezing of gait (FOG) events regarding the cueing-on and cueing-off situations were the main measures of gait performance. Results: Twelve patients with Parkinson's disease were recruited. Demographic and clinical characteristics of the participants were the following [median (interquartile range)]: age 63 years (57e67.3 years), Hoehn and Yahr stage 3.0 (3.0e3.25), and Unified Parkinson's Disease Rating Scale motor subsection off medication 22.5 (20.3e35.5). Walking turns of 180 in combination with a manual task were the most important triggers for FOG. On circular walking either with or without a manual task, visual or dual cues improved festinating gait patterns and increased step length. Visual or dual cues further improved the velocity of walking with a manual task. All types of cueing decreased FOG scores either with or without a manual task. Conclusion: Our study suggests that cueing improves festinating gait and decreases the incidence of FOG. Future studies with much larger sample sizes are warranted to support our findings.
Impaired step-length setting prior to turning in Parkinson's disease patients with freezing of gait
Movement disorders : official journal of the Movement Disorder Society, 2018
Impaired stride-length setting is implicated in the development of freezing of gait (FOG) in PD, with reduced mean step-length superimposed on a successively reduced step-length (sequence effect) leading to freezing episodes. 1 The majority of PD patients note FOG during gait initiation and/or turning. 2 While the first three steps on gait initiation were shorter in FOG subjects, 3 successively reduced step-length prior to turning has not been directly demonstrated. Our goal was to determine if prior to a turn, step-length setting was differentially affected in PD FOG patients.
Freezing of gait in Parkinson's disease: The impact of dual-tasking and turning
Movement Disorders, 2010
Background: Turning is the most important trigger for freezing of gait (FOG) in Parkinson's disease (PD), and dual-tasking has been suggested to influence FOG as well. Objective: To understand the effects of dual tasking and turning on FOG. Methods: 14 Freezers and 14 nonfreezers matched for disease severity and 14 age-matched controls were asked to turn 1808 and 3608 with and without a cognitive dual-task during the off-period of the medication cycle. Total number of steps, duration, cadence, freezing-frequency, and secondary-task performance were measured. Results: Seven freezers froze during the protocol. Freezing occurred in 37.5% of trials during 1808 turning compared to 0% during straight-line walking (X 2 5 10.44, p < 0.01). The occurrence of FOG increased during 3608 when also a dual-task was added (X 2 5 4.23, p 5 0.04). Freezers took significantly more steps and were slower than controls in all conditions. The presence of a dual-task increased these differences. Cadence increased significantly for freezers during 3608 and 1808 compared to straight-line walking. In contrast, cadence was decreased during turning in controls and non-freezers. During straight-line walking, only freezers made errors in the secondary task. Controls increased their error-rate during 1808 turning, whereas freezers deteriorated their secondary task performance during 3608. Conclusions: 3608 turning in combination with a dual-task is the most important trigger for freezing. During turning, non-freezers and controls decreased their cadence whereas freezers increased it, which may be related to FOG. Freezers adopted a posture second strategy in contrast to non-freezers when confronted with a dual task.
Walking patterns in Parkinson's disease with and without freezing of gait
Neuroscience, 2011
The pathophysiology underlying freezing of gait (FOG) in Parkinson's disease remains incompletely understood. Patients with FOG ("freezers") have a higher temporal variability and asymmetry of strides compared to patients without FOG ("non-freezers"). We aimed to extend this view, by assessing spatial variability and asymmetry of steps and interlimb coordination between the upper and lower limbs during gait. Twelve freezers, 15 non-freezers, and 15 agematched controls were instructed to walk overground and on a treadmill. Kinematic data were recorded with a motion analysis system. Both freezers and non-freezers showed an increased spatial variability of leg movements compared to controls. In addition, both patient groups had a deficit in interlimb coordination, not only between ipsilateral arms and legs, but also between diagonally positioned limbs. The only difference between freezers and non-freezers was a decreased step length during treadmill walking. We conclude that parkinsonian gait-regardless of FOG-is irregular, not only in the legs, but also with respect to interlimb coordination between the arms and legs. FOG is reflected by abnormal treadmill walking, presumably because this provides a greater challenge to the defective supraspinal control than overground walking, hampering the ability of freezers to increase their stride length when necessary.
Freezing of Gait in Parkinson’s Disease: Implications for Dual-Task Walking
Journal of Parkinson's Disease
Background: The simultaneous completion of multiple tasks (dual-tasking, DT) often leads to poorer task performance (DT cost, DTC). People with Parkinson’s disease (PwPD) exhibit difficulty with DT, and DTC may be particularly pronounced in PwPD with freezing of gait (FOG). Objective: This study assessed the relationship between FOG status and DTC during gait. Methods: Gait parameters were collected using inertial sensors in 106 PwPD (off-medication), including definite-freezers (dFOG; n = 25), possible-freezers (pFOG; n = 16), and non-freezers (nFOG; n = 65) during single (ST)-and DT walking. Results: PwPD with dFOG had larger (worse) DTC than nFOG for foot-strike angle, stride length, toe-off angle, variability of foot-strike angle, and arm range of motion (ROM). After accounting for covariates, the toe-off angle and stride length remained worse in PwPD who freeze. Worse cognition predicted larger DTC for stride length, gait cycle duration, gait speed, and step duration across gro...
Dual Task Turning in Place: A Reliable, Valid, and Responsive Outcome Measure of Freezing of Gait
Movement Disorders, 2021
BackgroundFreezing of gait (FOG) is a complex symptom in Parkinson's disease (PD) that is both elusive to elicit and varied in its presentation. These complexities present a challenge to measuring FOG in a sensitive and reliable way, precluding therapeutic advancement.ObjectiveWe investigated the reliability, validity, and responsiveness of manual video annotations of the turning‐in‐place task and compared it to the sensor‐based FOG ratio.MethodsForty‐five optimally medicated people with PD and FOG performed rapid alternating 360° turns without and with an auditory stroop dual task, thrice over two consecutive days. The tasks were video recorded, and inertial sensors were placed on the lower back and shins. Interrater reliability between three raters, criterion validity with self‐reported FOG, and responsiveness to single‐session split‐belt treadmill (SBT) training were investigated and contrasted with the sensor‐based FOG ratio.ResultsVisual ratings showed excellent agreement b...
Applied Sciences
The risk of falls is common in the aging and Parkinson’s disease (PD) populations. There is limited research on dynamic gait stability, i.e., margin of stability (MOS), in the PD population while turning. The purpose of this exploratory study was to examine the dynamic balance control in individuals with mild to moderate PD and healthy individuals while walking and performing 90° turns utilizing computerized three-dimensional gait analysis. Specifically, we examined the anteroposterior and mediolateral margins of stability and their effect on the dynamic balance during turning in participants. A total of 11 individuals with mild to moderate idiopathic PD and 10 healthy controls (CON) participated in this study. Individuals with PD were tested during the “on phase” of PD medication. The Vicon Nexus camera system, force plates, and Visual3D software were utilized for three-dimensional motion analysis of three right and three left turning trials. A mixed-model ANOVA was used to analyze...