Physiological and Biomechanical Analyses of Rigidity in Parkinson's Disease

Xia, Ruiping

doi:10.5772/17849

Cited by 13 publications

(10 citation statements)

References 95 publications

(147 reference statements)

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“…Expert neurologists can commit an error of up to 20% in assessing rigidity (Rizzo et al, 2016). Other instrumented clinical tests allow the evaluation of objective continuous parameters overcoming the limitations of the UPDRS rating scale, which include surface electromyography (Eisen, 1987;Andreeva and Khutorskaya, 1996), myometry (Marusiak et al, 2010), and/or torque measuring devices (Kirollos et al, 1996;Patrick et al, 2001;Endo et al, 2009;Xia et al, 2011;Powell et al, 2012;Zetterberg et al, 2015). However, to the best of our knowledge, all the methods previously proposed in literature focused on the objective quantification of upper limbs rigidity (Ferreira-Sánchez et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Rigidity is clinically described as a constant increased resistance to a passive or externally induced motion throughout the range of movement (Fung and Thompson, 2002). Rigidity generally responds well to dopaminergic medication and surgical interventions (Xia, 2011), therefore representing an indicator of treatment response in clinical management and may also be used as a metric for pain and impaired mobility, as patients perceive rigidity as aching and stiffness in the muscles and joints.…”

Section: Introductionmentioning

confidence: 99%

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Biomechanical outcomes of the pendulum test characterize individual differences in activated versus resting leg rigidity in people with Parkinson’s disease

Martino

McKay

Factor

et al. 2020

Preprint

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Leg rigidity is associated with frequent falls in people with Parkinson's disease (PD), suggesting a potential role in functional balance and gait impairments. Changes in neural state due to secondary tasks, e.g. activation maneuvers, can exacerbate (or 'activate') rigidity, possibly increasing the risk of falls. However, the subjective interpretation and coarse classification of the standard clinical rigidity scale has prohibited the systematic, objective assessment of resting and activated leg rigidity. The pendulum test is an objective diagnostic method that we hypothesized would be sensitive enough to characterize resting and activated leg rigidity. We recorded kinematic data during the pendulum test in 15 individuals with PD, spanning a range of leg rigidity severity (slight to severe). From the recorded data of leg swing kinematics we measured biomechanical outcomes including first swing excursion, first extension peak, number and duration of the oscillations, resting angle, relaxation index, maximum and minimum angular velocity. We examined associations between biomechanical outcomes and clinical leg rigidity score. We evaluated the effect of increasing rigidity through activation maneuvers on biomechanical outcomes. Finally, we assessed whether either biomechanical outcomes or changes in outcomes with activation were associated with fall history. Our results suggest that the biomechanical assessment of the pendulum test can objectively quantify leg rigidity among people with PD. We found that the presence of marked rigidity during clinical exam significantly impacted biomechanical outcomes, i.e. first extension peak, number of oscillations, relaxation index and maximum angular velocity. No differences in the effect of activation maneuvers between groups with clinically assessed moderate and marked rigidity were observed, suggesting that activated rigidity may be independent of resting rigidity and should be scored as independent variables. Moreover, we found that fall history was more common among people whose rigidity was increased with a secondary task, as measured by biomechanical outcomes. We conclude that different mechanisms contributing to resting and activated rigidity may play an important yet unexplored functional role in balance impairments. The pendulum test may contribute to a better understanding of fundamental mechanisms underlying motor symptoms in PD, evaluating the efficacy of treatments, and predicting the risk of falls.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Biomechanical outcomes of the pendulum test characterize individual differences in activated versus resting leg rigidity in people with Parkinson’s disease

Martino

McKay

Factor

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…Postural instability is generally not responsive to dopamine replacement. Numerous physiological studies have shown the effects of dopaminergic medications and DBS on reducing bradykinesia [63,64] , rigidity [65][66][67][68][69] , and tremor [70,71] in patients with PD. The occurrence of falls and gait dysfunctions associated with postural instability is an important determinant of patients' quality of life [72] .…”

Section: Therapeutic Interventions For Motor Symptoms In Pdmentioning

confidence: 99%

Progression of motor symptoms in Parkinson’s disease

2012

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Parkinson's disease (PD) is a chronic progressive neurodegenerative disease that is clinically manifested by a triad of cardinal motor symptoms - rigidity, bradykinesia and tremor - due to loss of dopaminergic neurons. The motor symptoms of PD become progressively worse as the disease advances. PD is also a heterogeneous disease since rigidity and bradykinesia are the major complaints in some patients whereas tremor is predominant in others. In recent years, many studies have investigated the progression of the hallmark symptoms over time, and the cardinal motor symptoms have different rates of progression, with the disease usually progressing faster in patients with rigidity and bradykinesia than in those with predominant tremor. The current treatment regime of dopamine-replacement therapy improves motor symptoms and alleviates disability. Increasing the dosage of dopaminergic medication is commonly used to combat the worsening symptoms. However, the drug-induced involuntary body movements and motor complications can significantly contribute to overall disability. Further, none of the currently-available therapies can slow or halt the disease progression. Significant research efforts have been directed towards developing neuroprotective or disease-modifying agents that are intended to slow the progression. In this article, the most recent clinical studies investigating disease progression and current progress on the development of disease-modifying drug trials are reviewed.

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“…Rigidity is clinically described as a constantly increased resistance to a passive or externally induced motion throughout the range of movement (Fung and Thompson, 2002 ). Rigidity generally responds well to dopaminergic medication and surgical interventions (Xia, 2011 ), and a reduction in rigidity is taken as an indicator of successful treatment. Parkinsonian patients perceive rigidity as achiness and stiffness in the muscles and joints affected, which is also used as a metric for pain and impaired mobility.…”

Section: Introductionmentioning

confidence: 99%

Neuromechanical Assessment of Activated vs. Resting Leg Rigidity Using the Pendulum Test Is Associated With a Fall History in People With Parkinson’s Disease

Martino

McKay

Factor

et al. 2020

Front. Hum. Neurosci.

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Leg rigidity is associated with frequent falls in people with Parkinson’s disease (PD), suggesting a potential role in functional balance and gait impairments. Changes in the neural state due to secondary tasks, e.g., activation maneuvers, can exacerbate (or “activate”) rigidity, possibly increasing the risk of falls. However, the subjective interpretation and coarse classification of the standard clinical rigidity scale has prohibited the systematic, objective assessment of resting and activated leg rigidity. The pendulum test is an objective diagnostic method that we hypothesized would be sensitive enough to characterize resting and activated leg rigidity. We recorded kinematic data and electromyographic signals from rectus femoris and biceps femoris during the pendulum test in 15 individuals with PD, spanning a range of leg rigidity severity. From the recorded data of leg swing kinematics, we measured biomechanical outcomes including first swing excursion, first extension peak, number and duration of the oscillations, resting angle, relaxation index, maximum and minimum angular velocity. We examined associations between biomechanical outcomes and clinical leg rigidity score. We evaluated the effect of increasing rigidity through activation maneuvers on biomechanical outcomes. Finally, we assessed whether either biomechanical outcomes or changes in outcomes with activation were associated with a fall history. Our results suggest that the biomechanical assessment of the pendulum test can objectively quantify parkinsonian leg rigidity. We found that the presence of high rigidity during clinical exam significantly impacted biomechanical outcomes, i.e., first extension peak, number of oscillations, relaxation index, and maximum angular velocity. No differences in the effect of activation maneuvers between groups with clinically assessed low rigidity were observed, suggesting that activated rigidity may be independent of resting rigidity and should be scored as independent variables. Moreover, we found that fall history was more common among people whose rigidity was increased with a secondary task, as measured by biomechanical outcomes. We conclude that different mechanisms contributing to resting and activated rigidity may play an important yet unexplored functional role in balance impairments. The pendulum test may contribute to a better understanding of fundamental mechanisms underlying motor symptoms in PD, evaluating the efficacy of treatments, and predicting the risk of falls.

show abstract

Physiological and Biomechanical Analyses of Rigidity in Parkinson's Disease

Cited by 13 publications

References 95 publications

Biomechanical outcomes of the pendulum test characterize individual differences in activated versus resting leg rigidity in people with Parkinson’s disease

Biomechanical outcomes of the pendulum test characterize individual differences in activated versus resting leg rigidity in people with Parkinson’s disease

Progression of motor symptoms in Parkinson’s disease

Neuromechanical Assessment of Activated vs. Resting Leg Rigidity Using the Pendulum Test Is Associated With a Fall History in People With Parkinson’s Disease

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