The Neuromodulatory Impact of Subthalamic Nucleus Deep Brain Stimulation on Gait and Postural Instability in Parkinson's Disease Patients: A Prospective Case Controlled Study

Szlufik, Stanisław; Kłoda, Maria; Friedman, Andrzej; Potrzebowska, I.; Gregier, Kacper; Mandat, Tomasz; Przybyszewski, Andrzej W.; Dutkiewicz, Justyna; Figura, Monika; Habela, Piotr; Koziorowski, Dariusz

doi:10.3389/fneur.2018.00906

Cited by 20 publications

(21 citation statements)

References 31 publications

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“…Trunk position in PD has been measured or assumed from muscle echo intensity of the abdominal wall [ 18 ], from review of video recordings [ 4 , 19 ], subjectively using the 0–4 MDS Unified Parkinson’s Disease Rating Scale [ 20 – 22 ], or through observation [ 23 ]. Here, we use objective ultrasound motion detection to study and quantify alterations of body position in patients with PD and consider the longer-term effectiveness of DBS in the STN.…”

Section: Introductionmentioning

confidence: 99%

Deep brain stimulation in the subthalamic nuclei alters postural alignment and adaptation in Parkinson’s disease

et al. 2021

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Parkinson’s disease (PD) can produce postural abnormalities of the standing body position such as kyphosis. We investigated the effects of PD, deep brain stimulation (DBS) in the subthalamic nucleus (STN), vision and adaptation on body position in a well-defined group of patients with PD in quiet standing and during balance perturbations. Ten patients with PD and 25 young and 17 old control participants were recruited. Body position was measured with 3D motion tracking of the ankle, knee, hip, shoulder and head. By taking the ankle as reference, we mapped the position of the joints during quiet standing and balance perturbations through repeated calf muscle vibration. We did this to explore the effect of PD, DBS in the STN, and vision on the motor learning process of adaptation in response to the repeated stimulus. We found that patients with PD adopt a different body position with DBS ON vs. DBS OFF, to young and old controls, and with eyes open vs. eyes closed. There was an altered body position in PD with greater flexion of the head, shoulder and knee (p≤0.042) and a posterior position of the hip with DBS OFF (p≤0.014). With DBS ON, body position was brought more in line with the position taken by control participants but there was still evidence of greater flexion at the head, shoulder and knee. The amplitude of movement during the vibration period decreased in controls at all measured sites with eyes open and closed (except at the head in old controls with eyes open) showing adaptation which contrasted the weaker adaptive responses in patients with PD. Our findings suggest that alterations of posture and greater forward leaning with repeated calf vibration, are independent from reduced movement amplitude changes. DBS in the STN can significantly improve body position in PD although the effects are not completely reversed. Patients with PD maintain adaptive capabilities by leaning further forward and reducing movement amplitude despite their kyphotic posture.

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Section: Introductionmentioning

confidence: 99%

Deep brain stimulation in the subthalamic nuclei alters postural alignment and adaptation in Parkinson’s disease

et al. 2021

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“…The ratio of single support time (SST) and double support time (DST) is consistent in a healthy population (4:1) [13,14]; in PD the DST is more lengthy [4,[15][16][17][18][19][20]. The PD gait is shuffling and slow, and the stride is shorter [7,18,20,21], although it sustains its natural width [18]. Contrary to a vastly accepted concept of decreased joint range in limbs during gait based on some published results [17,21], a meta-analysis found no significant decrease in range of motion (ROM) in any joint except the hip joint [18].…”

Section: Introductionmentioning

confidence: 99%

“…Pathology of the disease consists of loss of dopaminergic neurons in the brainstem and their projections to basal ganglia deterioration between excitatory and inhibitory neural oscillators [3] that leads to inappropriate extent and timing of movement sequences [4,5]. In addition to the cardinal motor symptoms (rest tremor, muscle rigidity, and bradykinesia), fatigue [1,6], postural instability [1,7], problems in turning [1,8], standing up, or movement initiation [1,9], and/or freezing of gait [1,10] are associated with the disease. All these symptoms disrupt the gait cycle [1,[6][7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

“…In addition to the cardinal motor symptoms (rest tremor, muscle rigidity, and bradykinesia), fatigue [1,6], postural instability [1,7], problems in turning [1,8], standing up, or movement initiation [1,9], and/or freezing of gait [1,10] are associated with the disease. All these symptoms disrupt the gait cycle [1,[6][7][8][9][10][11][12]. The ratio of single support time (SST) and double support time (DST) is consistent in a healthy population (4:1) [13,14]; in PD the DST is more lengthy [4,[15][16][17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

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Kinematic Relations during Double Support Phase in Parkinsonian Gait

et al. 2022

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The gait of Parkinson’s disease (PD) patients is shuffling, slow, and hesitant. We investigated peculiar gait relations during the double support phase (DSP) in PD patients and healthy controls. We used 3D motion capture (SIMI) to collect kinematic parameters of the natural gait of 11 PD patients (Hoehn and Yahr 2–3, 5 females, 6 males) tested on medication and the same-sized control sample (5 females, 6 males). The difference between groups was evaluated by the Mann-Whitney U test; for target parameters, the Spearman correlation was computed. Compared to the controls, the Parkinsonian step length index was significantly smaller (0.27 vs. 0.35, p < 0.05), step width index higher (0.12 vs. 0.09, p < 0.05), and the DSP duration was extended (0.165 s vs. 0.13 s, p < 0.05), whereas the single support phase was shortened (0.38 s vs. 0.4 s, p < 0.05). The Parkinsonians were faster during DSP initiation and slower during DSP termination (0.908 m·s−1 vs. 0.785 m·s−1, p < 0.05); the Parkinsonian speed was more constant. The patients showed significantly decreased range of motion (ROM) in the hip, ankle, and shoulder and adopted straighter posture during the gait. Understanding gait concatenations can update physiotherapy approaches to target the roots of movement problems instead of the consequences.

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“…Regarding current therapeutic interventions, levodopa and deep-brain stimulation (DBS) therapies do not effectively improve balance control in PD in the disease progress and no long-term efficacy of either therapy has been proven for PD postural instability (13)(14)(15)(16). This instability may be related to dopaminergic disruption to the neural integration of jerk or sway.…”

Section: Introductionmentioning

confidence: 99%

Cortical and Cerebellar Oscillatory Responses to Postural Instability in Parkinson's Disease

et al. 2021

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Introduction: Posture and balance dysfunctions critically impair activities of daily living of patients with progressing Parkinson's disease (PD). However, the neural mechanisms underlying postural instability in PD are poorly understood, and specific therapies are lacking. Previous electrophysiological studies have shown distinct cortical oscillations with a significant contribution of the cerebellum during postural control tasks in healthy individuals.Methods: We investigated cortical and mid-cerebellar oscillatory activity via electroencephalography (EEG) during a postural control task in 10 PD patients with postural instability (PDPI+), 11 PD patients without postural instability (PDPI–), and 15 age-matched healthy control participants. Relative spectral power was analyzed in the theta (4–7 Hz) and beta (13–30 Hz) frequency bands.Results: Time-dependent postural measurements computed by accelerometer signals showed poor performance in PDPI+ participants. EEG results revealed that theta power was profoundly lower in mid-frontal and mid-cerebellar regions during the postural control task in PDPI+, compared to PDPI– and control participants. In addition, theta power was correlated with postural control performance in PD subjects. No significant changes in beta power were observed. Additionally, oscillatory changes during the postural control task differed from the resting state.Conclusion: This study underlines the involvement of mid-frontal and mid-cerebellar regions in postural stability during a balance task and emphasizes the important role of theta oscillations therein for postural control in PD.

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The Neuromodulatory Impact of Subthalamic Nucleus Deep Brain Stimulation on Gait and Postural Instability in Parkinson's Disease Patients: A Prospective Case Controlled Study

Cited by 20 publications

References 31 publications

Deep brain stimulation in the subthalamic nuclei alters postural alignment and adaptation in Parkinson’s disease

Deep brain stimulation in the subthalamic nuclei alters postural alignment and adaptation in Parkinson’s disease

Kinematic Relations during Double Support Phase in Parkinsonian Gait

Cortical and Cerebellar Oscillatory Responses to Postural Instability in Parkinson's Disease

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