Repetitive stepping in place identifies and measures freezing episodes in subjects with Parkinson's disease

Nantel, Julie; Solages, Camille de; Brontë‐Stewart, Helen

doi:10.1016/j.gaitpost.2011.05.020

Cited by 94 publications

(138 citation statements)

References 25 publications

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“…We found that stepping in place had a sensitivity of 0.38 to provoke FOG, which is lower than in previous work (sensitivity of 0.87) [5]. As study populations were largely comparable in both studies, this discrepancy may be explained by task duration, because Nantel and colleagues [5] instructed their patients to perform the stepping test for a period of 300 seconds (three times 100 seconds), whereas we used a much shorter time frame of 30 seconds (this was done on purpose, with the aim of developing a brief test that would be feasible for use in a busy daily clinical practice).…”

contrasting

confidence: 87%

“…to provoke FOG. Stepping in place and rapid turning on the spot are both effective ways to provoke FOG [5][6][7][8]. However, these two tests have not been compared back to back.…”

mentioning

confidence: 99%

“…As study populations were largely comparable in both studies, this discrepancy may be explained by task duration, because Nantel and colleagues [5] instructed their patients to perform the stepping test for a period of 300 seconds (three times 100 seconds), whereas we used a much shorter time frame of 30 seconds (this was done on purpose, with the aim of developing a brief test that would be feasible for use in a busy daily clinical practice). In contrast to the stepping in place test, our findings on the effectiveness of full rapid turns to provoke FOG (with a sensitivity of 0.88) are in accordance with two previous studies, which reported sensitivities of 0.64 and 0.65 [6,8].…”

mentioning

confidence: 99%

See 2 more Smart Citations

Provoking Freezing of Gait in Clinical Practice: Turning in Place is More Effective than Stepping in Place

Dijsseldonk

Wang

Wezel

et al. 2018

JPD

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Freezing of gait (FOG) is common and debilitating in Parkinson's disease (PD) [1], and significantly contributes to the occurrence of falls [2]. To prevent falls and fall-related injuries, timely detection of FOG in clinical practice is needed, as this can be the start of tailored interventions [3]. However, provoking FOG in a clinical environment is challenging, for several reasons. First, freezing is provoked by constraints in the physical environment, and the typically wide and well-lit hospital corridors are not ideal to provoke FOG. Moreover, clinicians are usually on a tight schedule and do not always have time to perform a complete FOG-provoking test battery [4]. It is therefore important to identify the most effective task * Correspondence to: Jorik Nonnekes, MD, PhD, Radboud University Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands. E-mail: jorik.nonnekes@radboudumc.nl. to provoke FOG. Stepping in place and rapid turning on the spot are both effective ways to provoke FOG [5][6][7][8]. However, these two tests have not been compared back to back. Moreover, it is unknown whether combining both tests yields a higher sensitivity than either test alone.To answer these questions, we included 16 patients with PD and subjective experience of daily FOG, as determined using the N-FOGQ [9]. Mean age of these patients was 70 years (range 51-89 years), with a mean disease duration of 10 years (range 3-20), mean MDS-UPDRS subsection III score of 36 (range 24-49) and mean N-FOGQ score of 19 (range 10-25). Hoehn and Yahr staging showed a modal score of 2 (range 2-4). All patients were examined in a practically defined OFF state, i.e., >12 hours after intake of the last dose of dopaminergic medication.

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contrasting

confidence: 87%

“…to provoke FOG. Stepping in place and rapid turning on the spot are both effective ways to provoke FOG [5][6][7][8]. However, these two tests have not been compared back to back.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Provoking Freezing of Gait in Clinical Practice: Turning in Place is More Effective than Stepping in Place

Dijsseldonk

Wang

Wezel

et al. 2018

JPD

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“…The study was approved by our Institutional Review Board. Motor task Participants were asked to stand upright with their arms along their sides and step in place at a comfortable pace for 60 s [30]. SIP trials, were performed on two force platforms recording at 200 Hz (Kistler, Winterthur, Switzerland).…”

Section: Methodsmentioning

confidence: 99%

“…Therefore, it reduces the need to regulate postural balance, and allows primarily assessing the regulation of the stepping action. SIP has been validated [30] and used as a surrogate to gait to assess stepping variability in individuals with Parkinson’s disease [10, 30] and subsequently in virtual reality protocols in PD [31, 32]. …”

Section: Introductionmentioning

confidence: 99%

Executive function is necessary for the regulation of the stepping activity when stepping in place in older adults

2015

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To determine the effect of age on stepping performance and to compare the cognitive demand required to regulate repetitive stepping between older and younger adults while performing a stepping in place task (SIP). Fourteen younger (25.4 ± 6.5) and 15 older adults (71.0 ± 9.0) participated in this study. They performed a seated category fluency task and Stroop test, followed by a 60 s SIP task. Following this, both the cognitive and motor tasks were performed simultaneously. We assessed cognitive performance, SIP cycle duration, asymmetry, and arrhythmicity. Compared to younger adults, older adults had larger SIP arrhythmicity both as a single task and when combined with the Category (p < 0.001) and Stroop (p < 0.01) tasks. Older adults also had larger arrhythmicity when dual tasking compared to SIP alone (p < 0.001). Older adults showed greater SIP asymmetry when combined with Category (p = 0.006) and Stroop (p = 0.06) tasks. Finally, they had lower cognitive performance than younger adults in both single and dual tasks (p < 0.01). Age and type of cognitive task performed with the motor task affected different components of stepping. While SIP arrhythmicity was larger for all conditions in older compared to younger adults, cycle duration was not different, and asymmetry tended to be larger during SIP when paired with a verbal fluency task. SIP does not require a high level of control for dynamic stability, therefore demonstrating that higher-level executive function is necessary for the regulation of stepping activity independently of the regulation of postural balance. Furthermore, older adults may lack the cognitive resources needed to adequately regulate stepping activity while performing a cognitive task relying on the executive function.

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Identifying the neural correlates of doorway freezing in Parkinson's disease

Matar

Shine

Gilat

et al. 2019

Human Brain Mapping

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Freezing of gait (FOG) in Parkinson's disease (PD) is frequently triggered upon passing through narrow spaces such as doorways. However, despite being common the neural mechanisms underlying this phenomenon are poorly understood. In our study, 19 patients who routinely experience FOG performed a previously validated virtual reality (VR) gait paradigm where they used foot‐pedals to navigate a series of doorways. Patients underwent testing randomised between both their “ON” and “OFF” medication states. Task performance in conjunction with blood oxygenation level dependent (BOLD) signal changes between “ON” and “OFF” states were compared within each patient. Specifically, as they passed through a doorway in the VR environment patients demonstrated significantly longer “footstep” latencies in the OFF state compared to the ON state. As seen clinically in FOG this locomotive delay was primarily triggered by narrow doorways rather than wide doorways. Functional magnetic resonance imaging revealed that footstep prolongation on passing through doorways was associated with selective hypoactivation in the presupplementary motor area (pSMA) bilaterally. Task‐based functional connectivity analyses revealed that increased latency in response to doorways was inversely correlated with the degree of functional connectivity between the pSMA and the subthalamic nucleus (STN) across both hemispheres. Furthermore, increased frequency of prolonged footstep latency was associated with increased connectivity between the bilateral STN. These findings suggest that the effect of environmental cues on triggering FOG reflects a degree of impaired processing within the pSMA and disrupted signalling between the pSMA and STN, thus implicating the “hyperdirect” pathway in the generation of this phenomenon.

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Repetitive stepping in place identifies and measures freezing episodes in subjects with Parkinson's disease

Cited by 94 publications

References 25 publications

Provoking Freezing of Gait in Clinical Practice: Turning in Place is More Effective than Stepping in Place

Provoking Freezing of Gait in Clinical Practice: Turning in Place is More Effective than Stepping in Place

Executive function is necessary for the regulation of the stepping activity when stepping in place in older adults

Identifying the neural correlates of doorway freezing in Parkinson's disease

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