Impaired step‐length setting prior to turning in Parkinson's disease patients with freezing of gait

Virmani, Tuhin; Pillai, Lakshmi; Glover, Aliyah; Doerhoff, Shannon M.; Williams, David; García‐Rill, Edgar; Larson‐Prior, Linda J.

doi:10.1002/mds.27499

Cited by 22 publications

(14 citation statements)

References 7 publications

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“…The differences in destination SE between the two groups might be related to the differences in degree of BG function injury, and the PD+FOG group may be more severely injured. Similarly, there was a successive decrease in step length (SE) prior to turning or when passing a doorway in PD patients, and a significantly greater decline in step length was observed in the FOG patients ( 15 , 16 ). Due to impaired automation, gait control is often dependent on attention, especially in PD patients with FOG.…”

Section: Discussionmentioning

confidence: 94%

“…Similarly, there was a successive decrease in step length (SE) prior to turning or when passing a doorway in PD patients, and a significantly greater decline in step length was observed in the FOG patients (15,16). Due to impaired automation, gait control is often dependent on attention, especially in PD patients with FOG.…”

Section: Discussionmentioning

confidence: 99%

“…The severity of SE is influenced by environmental factors and varies between individuals, therefore the SE can be much greater under some circumstances ( 13 ). For example, it has been shown that prior to turning, the SE in PD patients with FOG was significantly greater than that in healthy people and PD patients without FOG, although all groups perform progressive step-to-step reduction ( 15 ). These could partly explain why turning induces freezing episodes in PD.…”

Section: Introductionmentioning

confidence: 99%

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Transverse Strips Instead of Wearable Laser Lights Alleviate the Sequence Effect Toward a Destination in Parkinson's Disease Patients With Freezing of Gait

et al. 2020

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Background: The sequence effect (SE), referring to step-to-step reduction in amplitude, is considered to lead to freezing of gait (FOG) in Parkinson's disease (PD). Visual cues may alleviate SE and help reduce freezing episodes. FOG patients show significant SE prior to turning or toward a doorway, but the SE toward a destination has not been clearly studied. Objectives: To examine the SE when approaching a destination in PD patients with FOG, and to further explore the effects of different types of visual cues on destination SE. Methods: Thirty-five PD patients were divided into a freezing (PD+FOG, n = 15) group and a non-freezing (PD-FOG, n = 20) group. Walking trials were tested under three conditions, including without cues (no-cue condition), with wearable laser lights (laser condition), and with transverse strips placed on the floor (strip condition). Kinematic data was recorded by a portable Inertial Measurement Unit (IMU) system. The destination SE and some key gait parameters were evaluated. Results: The PD+FOG group showed greater destination SE in the no-cue and laser conditions when compared to the PD-FOG group. There were no significant differences in the strip condition when comparing destination SE of the two groups. The destination SE was alleviated only by using the transverse strips on the floor. In contrast, transverse strips and wearable laser lights could increase the step length. Conclusions: The significant destination SE may explain why FOG patients are prone to freezing when heading toward their destination. Visual cues using transverse strips on the floor may be a more effective strategy for FOG rehabilitation in PD patients.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Transverse Strips Instead of Wearable Laser Lights Alleviate the Sequence Effect Toward a Destination in Parkinson's Disease Patients With Freezing of Gait

et al. 2020

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“…10,11,16 Additionally, the successive reduction in stride length, in the setting of an already reduced stride length (termed the sequence effect), has been suggested to provoke freezing of gait. 10,12,17 Stride velocity (SV) was chosen as slowing is a core feature of PD. Swing phase percent (Sw%) was chosen as decreased time spent in this phase of the gait cycle would suggest greater shuffling of gait.…”

Section: Methodsmentioning

confidence: 99%

“…Gait kinematics is clearly affected in PD patients with levodopa responsive freezing of gait. [9][10][11][12][13][14] Our objective in this study was to utilize a select number of spatiotemporal gait parameters that provide information on the salient features of gait and to determine their utility in gait optimization in patients with levodopa-unresponsive freezing of gait.…”

Section: Introductionmentioning

confidence: 99%

Utility of objective gait measures in levodopa‐unresponsive freezing in Parkinson's

Virmani

Glover

Pillai

et al. 2021

Clinical Case Reports

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Make a Left Turn: Cortico‐Striatal Circuitry Mediating the Attentional Control of Complex Movements

et al. 2021

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A BS TRACT: Background: In movement disorders such as Parkinson's disease (PD), cholinergic signaling is disrupted by the loss of basal forebrain cholinergic neurons, as well as aberrant activity in striatal cholinergic interneurons (ChIs). Several lines of evidence suggest that gait imbalance, a key disabling symptom of PD, may be driven by alterations in high-level frontal cortical and cortico-striatal processing more typically associated with cognitive dysfunction. Methods: Here we describe the corticostriatal circuitry that mediates the cognitive-motor interactions underlying such complex movement control. The ability to navigate dynamic, obstacle-rich environments requires the continuous integration of information about the environment with movement selection and sequencing. The corticalattentional processing of extero-and interoceptive cues requires modulation by cholinergic activity to guide striatal movement control. Cue-derived information is "transferred" to striatal circuitry primarily via frontostriatal glutamatergic projections. Result: Evidence from parkinsonian fallers and from a rodent model reproducing the dual cholinergicdopaminergic losses observed in these patients supports the main hypotheses derived from this neuronal circuitryguided conceptualization of parkinsonian falls. Furthermore, in the striatum, ChIs constitute a particularly critical node for the integration of cortical with midbrain dopaminergic afferents and thus for cues to control movements. Conclusion: Procholinergic treatments that enhance or rescue cortical and striatal mechanisms may improve complex movement control in parkinsonian fallers and perhaps also in older persons suffering from gait disorders and a propensity for falls.

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Impaired step‐length setting prior to turning in Parkinson's disease patients with freezing of gait

Cited by 22 publications

References 7 publications

Transverse Strips Instead of Wearable Laser Lights Alleviate the Sequence Effect Toward a Destination in Parkinson's Disease Patients With Freezing of Gait

Transverse Strips Instead of Wearable Laser Lights Alleviate the Sequence Effect Toward a Destination in Parkinson's Disease Patients With Freezing of Gait

Utility of objective gait measures in levodopa‐unresponsive freezing in Parkinson's

Make a Left Turn: Cortico‐Striatal Circuitry Mediating the Attentional Control of Complex Movements

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