This study provides evidence of a specific therapeutic effect of treadmill training on Parkinsonian gait and balance. Walking on a treadmill may be used as an easy, effective and accessible way to improve the stride length and balance in PD patients.
Background: The reviewed studies on center of pressure (COP) displacement in Parkinson's disease (PD) subjects show important methodological differences and contradictory results with regard to healthy subjects. The dual-task paradigm method has been used to examine cognitive prioritization strategies to control concurrent postural and cognitive tasks. The motor requirements, such as pronouncing words, involved in the cognitive tasks used in double-task conditions could be related to the heterogeneity of the results. Research Objective: To compare postural sway and cognitive performance in subjects with PD and controls using a dual-task paradigm with a cognitive task free of motor demands. We tried to examine the prioritization strategy of PD patients regarding healthy adults to control for concurrent postural and cognitive tasks. Materials and Methods: 25 subjects with PD and 20 healthy controls carried out a postural task under both single-task and dual-task conditions. The postural task was to stand as still as possible, with eyes first open and then closed. The dual-task condition added a concurrent cognitive task based on phoneme monitoring. COP displacement variables and cognitive performance were compared between the groups and withinsubject factors were also examined. Results: PD participants showed higher COP displacement results than the controls. All participants shortened the mean sway radius in dual-task conditions compared with single-task conditions; only healthy subjects presented less transversal COP sway in dual-task conditions than in single-task conditions. The cognitive performance of PD patients on a phoneme monitoring task worsened when they carried it out while maintaining balance in a standing position compared to sitting. The opposite effect occurred in control subjects. Conclusion: This study confirms the negative influence of Parkinson's disease on the control of standing stability, increasing the COP sway amplitude. The attentional
Aim: It is accepted that leg stiffness (K leg ) increases when surface stiffness decreases, and vice versa. However, little is known how the central nervous system fulfils this task. To understand the effect of surface stiffness on the neural control of stretch-shortening cycle movements, this study aimed to compare modulation of spinal and corticospinal excitability at distinct phases after ground contact during two-legged hopping when changing from solid to elastic ground. Methods: Motor-evoked potentials (MEPs) induced by transcranial magnetic stimulation (TMS) and H-reflexes were elicited at the time of the short (SLR)-, medium (MLR)-and long (LLR)-latency responses of the soleus muscle (SOL) during two-legged hopping on different stiffness surfaces, elastic and stiff. Results: Soleus H-reflexes during two-legged hopping on the elastic surface were lower at SLR and larger at LLR than on the stiff surface (P < 0.05 for both comparisons). SOL MEP size was higher at the time of SLR during hopping on the elastic surface than on the stiff surface (P < 0.05) although the background EMG was similar. Conclusion: It is argued that this phase-specific adaptation in spinal reflex excitability is functionally relevant to adjust leg stiffness to optimally exploit the properties of the elastic surface. Thus, the increased corticospinal excitability on the elastic surface may reflect a more supraspinal control of the ankle muscles to compensate the decrease in reflexive stiffness at the beginning of touchdown and/or counteract the higher postural challenges associated with the elastic surface. Keywords H-reflex, leg stiffness, stretch-shortening cycle, transcranial magnetic stimulation.The neural control of stretch-shortening cycle (SSC) movements such as drop jumps, two-legged hopping, or running is highly complex incorporating feedforward (pre-programmed) and feedback (reflex) control (Taube et al. 2012a). Thus, multiple hierarchical levels of the central nervous system (CNS) have to closely interact to adjust neural control task (Leukel et al. 2008a) and context specifically (Leukel et al. 2008a(Leukel et al. , 2012 taking into account the biomechanical constraints of the human body. The CNS is therefore challenged to optimally exploit the capacity of the tendomuscular system to store kinetic energy during 1 Published in which should be cited to refer to this work.http://doc.rero.ch the eccentric phase (touchdown), which can subsequently be released in the concentric phase (push-off) without exposing the body to the risk of being overloaded. It was previously demonstrated that the CNS can adjust the recoil properties of the tendomuscular system in various ways at different times of the SSC movement; for instance Arampatzis et al. (2001) showed that the level of pre-activation (muscular activity before touchdown) is related to the stiffness of the lower extremity. Furthermore, the reflex-induced activity shortly after touchdown can be modulated. Several studies observed reduced H-reflex activity with increasing d...
Gait disturbances are one of the principal and most incapacitating symptoms of Parkinson’s disease (PD). In addition, walking economy is impaired in PD patients and could contribute to excess fatigue in this population. An important number of studies have shown that treadmill training can improve kinematic parameters in PD patients. However, the effects of treadmill and overground walking on the walking economy remain unknown. The goal of this study was to explore the walking economy changes in response to a treadmill and an overground training program, as well as the differences in the walking economy during treadmill and overground walking. Twenty-two mild PD patients were randomly assigned to a treadmill or overground training group. The training program consisted of 5 weeks (3 sessions/week). We evaluated the energy expenditure of overground walking, before and after each of the training programs. The energy expenditure of treadmill walking (before the program) was also evaluated. The treadmill, but not the overground training program, lead to an improvement in the walking economy (the rate of oxygen consumed per distance during overground walking at a preferred speed) in PD patients. In addition, walking on a treadmill required more energy expenditure compared with overground walking at the same speed. This study provides evidence that in mild PD patients, treadmill training is more beneficial compared with that of walking overground, leading to a greater improvement in the walking economy. This finding is of clinical importance for the therapeutic administration of exercise in PD.
Startle stimuli lead to shorter reaction times in control subjects and Parkinson's disease (PD) patients. However, non-startle stimuli also enhance movement initiation in PD. We wanted to examine whether a startle-triggered movement would retain similar kinematic and EMG-related characteristics compared to one induced by a non-startle external cue in PD patients. In this study we investigated the electromyography pattern and the reaction time during a wrist flexion movement in response to three different stimuli: a visual imperative stimulus; visual stimulus simultaneous with a non-startle auditory stimulus and with a startle auditory stimulus. Ten PD patients and ten aged matched controls participated in this study. The reaction times were faster for startle and non-startle stimuli in comparison with the visual imperative stimulus, in both patients and control subjects. The startle cue induced a faster reaction than the non-startle cue. The electromyography pattern remained unchanged across the conditions. The results suggest that the startle reaction effect for upper limb movements are unimpaired in PD patients and has different characteristics than the effect of non-startle stimuli.
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